Blunt aortic injuries

Are they still lethal?

M. P. Munyikwa, Brian Daley, V. Rowe, John Mack

Research output: Contribution to journalArticle

Abstract

Purpose: Blunt Aortic Injuries (BAI) continue to be a challenging clinical problem. Eighty-five percent of victims die on scene, and of those who reach hospital, 30 percent die within 24 hours. We review our experience with BAI to see if 1)screening chest CT causes significant delay in rendering definitive treatment and 2) whether paraplegia is reduced by use of cardiopulmonary bypass. Methods: Retrospective analysis of patients admitted to the University of Tennessee Medical Center at Knoxville with BAI from January 1989 to December 1997. Data were collected from prehospital, hospital and autopsy records. Results: Of 13 565 adult trauma admissions, 71 patients sustained BAI (incidence = 0.52%). Nineteen patients died early (26.8%). Of those who survived surgery, five died (mortality = 9.6%), all from associated injuries. There was no significant difference in the ER arrival-to-OR interval between patients who had chest CT during their diagnostic workup and those who did not. Of the five patients who subsequently developed renal failure, only one had CT chest with contrast. The incidence of paraplegia was zero in patients with cross-clamp times less than 30 minutes. With longer cross-clamp times, three out of 34 patients (8.8%) on bypass developed paraplegia compared to seven of 22 patients (31.8%) repaired by the 'clamp-and-sew' technique (p<0.05) Conclusions: Operative treatment of BAI can be done with acceptable mortality. The use of screening CT chest is not a dangerous waste of time, and does not increase the renal failure rate. The risk of paraplegia can be reduced by the use of intraoperative bypass. Clinical Implications: The increasing use of screening chest CT does not delay operation and reduces the number of invasive aortograms, without risk of renal failure from the additional contrast, if both are needed. Use of bypass decreases risk of paraplegia.

Original languageEnglish (US)
JournalChest
Volume114
Issue number4 SUPPL.
StatePublished - Oct 1 1998

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Nonpenetrating Wounds
Paraplegia
Thorax
Renal Insufficiency
Mortality
Hospital Records
Patient Admission
Incidence
Wounds and Injuries
Cardiopulmonary Bypass
Autopsy
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Munyikwa, M. P., Daley, B., Rowe, V., & Mack, J. (1998). Blunt aortic injuries: Are they still lethal? Chest, 114(4 SUPPL.).

Blunt aortic injuries : Are they still lethal? / Munyikwa, M. P.; Daley, Brian; Rowe, V.; Mack, John.

In: Chest, Vol. 114, No. 4 SUPPL., 01.10.1998.

Research output: Contribution to journalArticle

Munyikwa, MP, Daley, B, Rowe, V & Mack, J 1998, 'Blunt aortic injuries: Are they still lethal?', Chest, vol. 114, no. 4 SUPPL..
Munyikwa MP, Daley B, Rowe V, Mack J. Blunt aortic injuries: Are they still lethal? Chest. 1998 Oct 1;114(4 SUPPL.).
Munyikwa, M. P. ; Daley, Brian ; Rowe, V. ; Mack, John. / Blunt aortic injuries : Are they still lethal?. In: Chest. 1998 ; Vol. 114, No. 4 SUPPL.
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abstract = "Purpose: Blunt Aortic Injuries (BAI) continue to be a challenging clinical problem. Eighty-five percent of victims die on scene, and of those who reach hospital, 30 percent die within 24 hours. We review our experience with BAI to see if 1)screening chest CT causes significant delay in rendering definitive treatment and 2) whether paraplegia is reduced by use of cardiopulmonary bypass. Methods: Retrospective analysis of patients admitted to the University of Tennessee Medical Center at Knoxville with BAI from January 1989 to December 1997. Data were collected from prehospital, hospital and autopsy records. Results: Of 13 565 adult trauma admissions, 71 patients sustained BAI (incidence = 0.52{\%}). Nineteen patients died early (26.8{\%}). Of those who survived surgery, five died (mortality = 9.6{\%}), all from associated injuries. There was no significant difference in the ER arrival-to-OR interval between patients who had chest CT during their diagnostic workup and those who did not. Of the five patients who subsequently developed renal failure, only one had CT chest with contrast. The incidence of paraplegia was zero in patients with cross-clamp times less than 30 minutes. With longer cross-clamp times, three out of 34 patients (8.8{\%}) on bypass developed paraplegia compared to seven of 22 patients (31.8{\%}) repaired by the 'clamp-and-sew' technique (p<0.05) Conclusions: Operative treatment of BAI can be done with acceptable mortality. The use of screening CT chest is not a dangerous waste of time, and does not increase the renal failure rate. The risk of paraplegia can be reduced by the use of intraoperative bypass. Clinical Implications: The increasing use of screening chest CT does not delay operation and reduces the number of invasive aortograms, without risk of renal failure from the additional contrast, if both are needed. Use of bypass decreases risk of paraplegia.",
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