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Acute traumatic disruption of the thoracic aorta: emergency department management
R L Warren1, C W Akins, A K Conn
1Department of Surgery, Massachusetts General Hospital, Boston.
Study Objective:
To evaluate the safety and effectiveness of temporary IV antihypertensive therapy in patients with acute traumatic thoracic aortic disruption.
Design:
Retrospective chart review of all patients treated for proven traumatic aortic disruption during the ten-year period of 1980 through 1989.
Setting:
Emergency department of a large, urban, Level I trauma center.
Interventions:
Preoperative IV beta-blockade and nitroprusside after initial resuscitation in hemodynamically stable patients.
Results:
Thirty-seven patients with angiographically proven aortic disruption were separated retrospectively into one of three groups. Group 1 (15 patients without preoperative antihypertensive therapy) had two deaths. Group 2 (15 patients treated for two to seven hours [mean, 3.8 hours] before surgery with antihypertensives) had one death. Group 3 (seven patients treated with antihypertensives for 24 hours to four months before surgery to allow recovery from associated severe injuries) had one death. There were no complications resulting from antihypertensive therapy.
Conclusion:
Temporary antihypertensive therapy appears to be safe and effective in patients with aortic disruption.