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Pack the chest: Damage control strategy for management in thoracic trauma
Anthony D Douglas1, Thaddeus J Puzio2, Patrick B Murphy3
1Indiana University School of Medicine, Indianapolis, IN, USA.
Injury
|March 24, 2024
Summary
Damage control thoracotomy (DCT) is a viable option for severe thoracic trauma, despite higher mortality. This approach offers similar ICU stay and ventilator days compared to definitive thoracotomy (DT).
Area of Science:
- Trauma Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Damage control surgery (DCS) aims to stabilize patients with severe injuries for later definitive treatment.
- Limited data exists on damage control thoracotomy (DCT) in trauma, and optimal temporary chest closure methods are unknown.
Purpose of the Study:
- To evaluate the outcomes of damage control thoracotomy (DCT) versus definitive thoracotomy (DT) in trauma patients.
- To compare patient characteristics, physiological derangements, and outcomes between DCT and DT.
Main Methods:
- Retrospective review of 76 trauma patients undergoing thoracotomy at two Level I trauma centers.
- Exclusion criteria included thoracotomy after 24 hours, age <16, or death before ICU admission.
- Statistical analysis using one-way ANOVA and Kruskal-Wallis test to compare variables between DCT and DT groups.
Main Results:
- DCT was performed in 30 patients (39%), while 46 (61%) underwent DT.
- DCT patients exhibited greater physiological derangement (HR, pH) and higher injury severity scores, requiring more transfusions.
- DCT had significantly higher mortality (63.3% vs. 5.0%), cardiac arrest, and unplanned return to OR rates, but similar ICU stay and ventilator days.
Conclusions:
- Damage control thoracotomy (DCT) is a feasible option for critically injured thoracic trauma patients.
- Higher mortality in DCT is likely due to initial injury severity and physiological status.
- DCT demonstrates comparable complication rates, ICU length of stay, and ventilator days to definitive thoracotomy (DT).
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