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Damage control thoracotomy trends, techniques, and outcomes: An EAST multicenter trial.

Anthony D Douglas1, Teddy Puzio, Partick Murphy

  • 1From the Department of Surgery (A.D.D., N.B., J.Finch., H.S., M.J.L.), Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery (T.Puzio), University of Texas Houston, Houston, Texas; Department of Surgery (P.M., J.Figueroa), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (J.N., D.C.), University of California Irvine, Irvine, California; Department of Surgery (H.K., A.G.), Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery (L.T.), Northwestern Medical Center, Chicago, Illinois; Department of Surgery (B.R.), University of Washington, Seattle, Washington; Department of Surgery (M.C.), Envision Physician Services Dallas LLC, Dallas, Texas; Department of Surgery (L.H., R.K.), University of Chicago Medicine, Chicago, Illinois; Department of Surgery (A.S.), University of Washington School of Medicine, Seattle, Washington; Department of Surgery (D.T.), Mayo Clinic College of Medicine and Science, Rochester, Wisconsin; Department of Surgery (G.W.), University Illinois Chicago, Chicago, Illinois; Department of Surgery (G.Capron), Cook County Health, Chicago, Illinois; Department of Surgery (A.V., B.B., A.K.), Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas; Department of Surgery (A.L.), Albert Einstein Medical Center, New York, New York; Department of Surgery (J.T., D.C.), University of Liverpool School of Medicine, Liverpool, UK; Department of Surgery (A.G.-S., T.Powers), Cooper Medical School of Rowan University, Camden, New Jersey; Department of Surgery (A.R., S.S.), Crozer Chester Medical Center, Upland, California; Department of Surgery (F.M., G.-I.P.), University General Hospital of Patras, Rio, Greece; Department of Surgery (J.R.), Hospital Dr. Sotero del Rio, Santiago de Chile, Chile; Department of Surgery (L.V.), Loma Linda University, Loma Linda, California; Department of Surgery (N.F.), Texas Health Harris Methodist Hospital, Fort Worth, Texas; Department of Surgery (L.F., R.M.), The University of Tennessee at Chattanooga, Chattanooga, Tennessee; Department of Surgery (C.S., K.S.), Grant Medical Center, Columbus, Ohio; Department of Surgery (L.S.), Alameda County Medical Center, Oakland, California; Department of Surgery (R.B.), Spartanburg Regional Medical Center, Spartanburg, South Carolina; Department of Surgery (S.D.), University of Kentucky College of Medicine, Lexington, Lexington; Department of Surgery (G.H., C.C.), University of California Davis Medical Center, Sacramento, California; Department of Surgery (G.Chang), University of Illinois Chicago, Chicago, Illinois; and Department of Surgery (A.D.M.), Indiana University Health, Indianapolis, Indianapolis, IN.

The Journal of Trauma and Acute Care Surgery
|May 28, 2025
PubMed
Summary

Damage-control thoracotomy (DCT) use is rising, showing more intensive care unit (ICU)-free days but no change in mortality. Temporary closure methods should align with surgeon expertise and available resources.

Keywords:
Traumacritical caredamage controlthoracotomy

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Area of Science:

  • Trauma Surgery
  • Surgical Critical Care
  • Thoracic Surgery

Background:

  • Damage-control thoracotomy (DCT) evidence regarding frequency, technique, and outcomes is limited.
  • This study addresses the lack of data on DCT utilization and associated results.

Purpose of the Study:

  • To examine DCT usage trends over a decade.
  • To evaluate temporary closure techniques in DCT.
  • To assess outcomes and complications associated with DCT.

Main Methods:

  • International retrospective cohort study (2008-2020) of 25 centers.
  • Included patients aged 16+ undergoing thoracotomy within 24 hours of admission, surviving to ICU.
  • Used mixed logistic regression and competing risk regression for analysis.

Main Results:

  • 402 of 922 thoracotomies (44%) were DCT, predominantly for penetrating injuries (66%).
  • Common temporary closures: commercial vacuum devices (30%) and adhesive dressings (32%).
  • DCT group had higher mortality (61% vs. 17%) and complications (pneumonia, acute renal failure, sepsis).

Conclusions:

  • DCT utilization is increasing, with improved ICU-free days but unchanged mortality.
  • No significant difference in complications based on temporary closure type.
  • Temporary closure selection should depend on operator experience and institutional resources.