Does Clamshell Thoracotomy Better Facilitate Thoracic Life-Saving Procedures Without Increased Complication Compared with an Anterolateral Approach to Resuscitative Thoracotomy? Results from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery Registry - 23/11/20

Doi : 10.1016/j.jamcollsurg.2020.09.002

Joseph J. DuBose, MD, FACS ^a,^⁎ , Jonathan Morrison, MD, PhD ^a, Laura J. Moore, MD, FACS ^b, Jeremy W. Cannon, MD, FACS ^c, Mark J. Seamon, MD, FACS ^c, Kenji Inaba, MD, FACS ^d, Charles J. Fox, MD, FACS ^e, Ernest E. Moore, MD, FACS ^e, David V. Feliciano, MD, FACS ^a, Thomas Scalea, MD, FACS ^a
for the
AAST AORTA Study Group
Jeanette M. Podbielski, RN, CCRP, John B. Holcomb, MD, Alice Piccinini, MD, David S. Kauvar, MD, FACS, Valorie L. Baggenstoss, MSN, RN, Catherine Rauschendorfer, BSN, RN, Chance Spalding, DO, PhD, Timothy W. Wolff, DO, David Turay, MD, Juan C. Quispe, MD, Xian Luo-Owen, PhD, David Skarupa, MD, Jennifer A. Mull, RN, CCRC, Yohan Diaz Zuniga, Joseph Ibrahim, MD, Karen Safcsak, RN, BSN, Stephanie Gordy, MD, Matthew Yanoff, MD, Andrew W. Kirkpatrick, MD, Chad G. Ball, MD, Zhengwen Xiao, MD, MSc, PhD, Elizabeth Dauer, MD, Jennifer Knight, MD, Nicole Cornell, BS, MS, Forrest “Dell” Moore, MD, Matthew Bloom, MD, Nam T. Tran, MD, Eileen Bulger, MD, FACS, Jeannette G. Ward, MS-CR, John K. Bini, MD, John Matsuura, MD, Joshua Pringle, MD, Karen Herzing, BSN, RN, Kailey Nolan, BS, Nathaniel Poulin, MD, William Teeter, MD, Rachel Nygaard, PhD, Chad Richardson, MD, Derek Lumbard, MD, Kathryn Johnson, MD, Reagan Bollig, MD, Brian Daley, MD, Niki Rasnake, BSN, RN, CEN, Marko Bukur, MD, Elizabeth Warnack, MD, Joseph Farhat, MD, Robert M. Madayag, MD, FACS, Pamela Bourg, PhD, RN, TCRN, FAEN, Dafney Davare, MD, Seong Lee, MD, Rachele Solomon, MPH

^a Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD
^b Department of Surgery, University of Texas Health Sciences Center–Houston, Houston, TX
^c Department of Surgery, University of Pennsylvania, Philadelphia, PA
^d Department of Surgery, Los Angeles County + University of Southern California Hospital, Los Angeles, CA
^e Department of Surgery, Denver Health and Hospital Authority, Denver, CO

^∗Correspondence address: Joseph J DuBose, MD, FACS, R Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 South Greene St, Room T4M14, Baltimore, MD 21201.R Adams Cowley Shock Trauma CenterUniversity of Maryland Medical System22 South Greene St, Room T4M14BaltimoreMD21201

Abstract

Background

Resuscitative thoracotomy (RT) is life-saving in select patients and can be accomplished through a left anterolateral (AT) or clamshell thoracotomy (CT). CT may provide additional exposure, facilitating certain operative procedures, but the added blood and heat loss and time to perform it may increase complications. No prospective multicenter comparison of techniques has yet been reported.

Study Design

The observational AAST Aortic Occlusion for Resuscitation in Trauma and Acute care surgery (AORTA) registry was used to compare AT and CT in RT.

Results

AORTA recorded 1,218 RTs at 46 trauma centers from June 2014 to January 2020. Overall survival after RT was 6.0% (AT 6.6%; [59 of 900]; CT 4.2% [13 of 296], p = 0.132). Among all RTs, 11.1% (142 of 1,278) surviving at least 24 hours were used tocompare AT (112) and CT (30). There was no difference between the 2 groups withregard to age, sex, Injury Severity Score, or mechanism of injury (Table 1). CT was significantly more likely to be used in patients needing resection of the lung or cardiac repair. CT was not associated with increased local thoracic/systemic complications, higher transfusion requirement, or greater ventilator, ICU, or hospital days compared with AT.

Conclusions

Clamshell thoracotomy facilitates thoracic life-saving procedures withoutincreased systemic or thoracic complications compared with AT in patients undergoing RT.

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Abbreviations and Acronyms : AAST, AIS, AORTA, AT, CT, IQR, ISS, RT

Esquema

	Members of the AAST AORTA Study Group who co-authored this article are listed in the Appendix.
	Disclosure Information: Nothing to disclose.
	Disclaimer: This work represents the authors' own work. The opinions and assertions contained herein are not to be considered as official or reflecting the views of the US Air Force or the Department of Defense.
	Data accepted for podium presentation at the 79^th Annual American Association for the Surgery of Trauma virtual meeting, September 2020.

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Vol 231 - N° 6

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