Prospective study of blunt aortic injury: Multicenter trial of the American Association for the Surgery of Trauma

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Abstract

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 multi-center 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 ≤30 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.

Original languageEnglish
Pages (from-to)374-382
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume42
Issue number3
DOIs
StatePublished - Mar 1997
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Prospective study of blunt aortic injury : Multicenter trial of the American Association for the Surgery of Trauma. / Fabian, Timothy C.; Richardson, J. David; Croce, Martin A.; Smith, J. Stanley; Rodman, George; Kearney, Paul A.; Flynn, William; Ney, Arthur L.; Cone, John B.; Luchette, Fred A.; Wisner, David H.; Scholten, Donald J.; Beaver, Bonnie L.; Conn, Alasdair K.; Coscia, Robert; Hoyt, David B.; Morris, John A.; Harviel, J. Duncan; Peitzman, Andrew B.; Bynoe, Raymond P.; Diamond, Daniel L.; Wall, Matthew; Gates, Jonathan D.; Asensio, Juan A.; McCarthy, Mary C.; Girotti, Murray J.; VanWijngaarden, Mary; Cogbill, Thomas H.; Levison, Marc A.; Aprahamian, Charles; Sutton, John E.; Allen, C. F.; Hirsch, Erwin F.; Nagy, Kimberly; Bachulis, Ben L.; Bales, Charles R.; Shapiro, Marc J.; Metzler, Michael H.; Conti, Vincent R.; Baker, Christopher C.; Bannon, Michael P.; Ochsner, M. Gage; Thomason, Michael H.; Hiatt, Jonathan R.; O'Malley, Keith; Obeid, Farouck N.; Gray, Perry; Bankey, Paul E.; Knudson, M. Margaret; Dyess, Donna Lynn; Enderson, Blaine L.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 42, No. 3, 03.1997, p. 374-382.

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