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Factors Affecting Early Exsanguination and Death in Blunt Thoracic Aortic Trauma

University of Massachusetts Medical School, Division of Cardiac Surgery, Mary Imogene Bassett Hospital, New York, USA
¹ St. Mary s Good Samaritan Hospital, Illinois, USA
² University of Massachusetts Medical School, Department of Radiology, UMass Memorial Medical Center, Massachusetts, USA

For reprint information contact: Robert A Lancey, MD Tel: 1 607 547 4770 Fax: 1 607 547 4786 Email: robert.lancey{at}bassett.org Director, Division of Cardiac Surgery, Mary Imogene Bassett Hospital, 1 Atwell Road, Cooperstown, NY 13326, USA.

The traditional approach to blunt thoracic aortic injuries has been expedient diagnosis and operative repair due to the significant risk of early exsanguination and death in initial survivors. Nonoperative management has been advocated in patients with multiple injuries to reduce the operative mortality. However, specific clinical parameters and diagnostic tests that may predict the risk of early exsanguination and death have yet to be identified. A retrospective analysis of 80 patients with these injuries was undertaken to identify factors associated with early exsanguination or death. Available aortograms were also examined and graded to determine their utility in predicting these outcomes. Early exsanguination and death were found to be associated with low systolic blood pressure on admission and with short duration from injury to diagnosis. Exsanguination was also associated with the total number of lesions in thoracic injuries, and mortality with age greater than 30 years. Aortographic appearance was not found to correlate with either outcome. Patients with blunt thoracic aortic injuries should continue to be managed expediently, with immediate surgical repair if not contraindicated by associated injuries, to avoid early rupture.

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