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Prospective Study of Blunt Aortic Injury: Multicenter Trial of the American Association for the Surgery of Trauma.
Fabian, Timothy C. MD; Richardson, J. David MD; Croce, Martin A. MD; Smith, J. Stanley Jr., MD; Rodman, George Jr., MD; Kearney, Paul A. MD; Flynn, William MD; Ney, Arthur L. MD; Cone, John B. MD; Luchette, Fred A. MD; Wisner, David H. MD; Scholten, Donald J. MD; Beaver, Bonnie L. MD; Conn, Alasdair K. MD; Coscia, Robert MD; Hoyt, David B. MD; Morris, John A. Jr., MD; Harviel, J. Duncan MD; Peitzman, Andrew B. MD; Bynoe, Raymond P. MD; Diamond, Daniel L. MD; Wall, Matthew MD; Gates, Jonathan D. MD; Asensio, Juan A. MD; McCarthy, Mary C. MD; Girotti, Murray J. MD; VanWijngaarden, Mary MD; Cogbill, Thomas H. MD; Levison, Marc A. MD; Aprahamian, Charles MD; Sutton, John E. Jr., MD; Allen, C. F. MD; Hirsch, Erwin F. MD; Nagy, Kimberly MD; Bachulis, Ben L. MD; Bales, Charles R. MD; Shapiro, Marc J. MD; Metzler, Michael H. MD; Conti, Vincent R. MD; Baker, Christopher C. MD; Bannon, Michael P. MD; Ochsner, M. Gage MD; Thomason, Michael H. MD; Hiatt, Jonathan R. MD; O'Malley, Keith MD; Obeid, Farouck N. MD; Gray, Perry MD; Bankey, Paul E. MD; Knudson, M. Margaret MD; Dyess, Donna Lynn MD; Enderson, Blaine L. MD
Journal of Trauma-Injury Infection & Critical Care.
42(3):374-383, March 1997.
Background: Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years.
Methods: This study was a prospectively conducted multicenter trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma.
Results: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of > or = to30 minutes (p=0.01) to be associated with development of postoperative paraplegia.
Conclusions: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.
Copyright (C) 1997 Wolters Kluwer Health, Inc. All rights reserved.