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Trauma Pneumonectomy: Has Survival Improved Over Two Decades?
Seema P Anandalwar1, Amar Deshwar1, Elizabeth Powell1
1Department of Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA.
The American Surgeon
|April 23, 2025
Summary
Recent advances in trauma pneumonectomy care, including thoracic damage control and venovenous extracorporeal membrane oxygenation (VV-ECMO), significantly reduced late mortality. Early mortality remains high, but improved management strategies offer hope for better long-term survival in these critical patients.
Area of Science:
- Trauma Surgery
- Cardiopulmonary Support
- Critical Care Medicine
Background:
- Trauma pneumonectomy is a life-threatening procedure with historically high mortality rates.
- Advances in critical care and surgical techniques may impact outcomes for these patients.
- Evaluating changes in management over time is crucial for understanding survival trends.
Purpose of the Study:
- To test the hypothesis that improved mechanical cardiopulmonary support and operative management have enhanced survival in trauma pneumonectomy patients.
- To compare outcomes between two distinct time periods (2003-2010 and 2011-2023) to identify trends in survival and management.
Main Methods:
- Retrospective single-center study of 20 patients undergoing pneumonectomy for trauma between 2003 and 2023.
- Data collected included demographics, physiological parameters, use of venovenous extracorporeal membrane oxygenation (VV-ECMO), and mortality (early and late).
- Outcomes were analyzed and compared between the first (2003-2010) and second (2011-2023) decades.
Main Results:
- While Injury Severity Score (ISS) and overall/early mortality showed no significant difference between decades, late mortality dramatically decreased in the second decade (9% vs 50%).
- The second decade saw increased use of thoracic damage control surgery (100% vs 33%) and VV-ECMO with lung rest ventilation (64% vs 22%).
- Patients in the second decade presented with more severe physiological derangements (lower pH, higher base deficit), indicating more critical illness at presentation.
Conclusions:
- Despite persistent high early mortality, the combination of thoracic damage control surgery and early initiation of VV-ECMO appears to be a key factor in the significant reduction of late mortality.
- These findings suggest that modern critical care and surgical strategies have improved long-term survival for patients requiring trauma pneumonectomy.
- Further research into optimizing these interventions is warranted to further improve outcomes in this high-risk patient population.
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