Adherence of Impulse Control in Primary Management of Grade I and II Blunt Thoracic Aortic Injury

Recent studies have demonstrated no increased risk for mortality and excellent to intermediate outcomes with nonoperative management of grade I and II injuries. We aimed to evaluate the adherence of impulse control therapy for patients presenting with grade I-II blunt thoracic aortic injury (BTAI).

A retrospective chart review of patients who sustained BTAI at a level 1 trauma center from 2019 to 2023 was performed. Demographics, medical therapy, and management strategies were extracted.

One hundred fifteen patients with BTAI were identified, of whom 65 were included in the study (42 grade I and 23 grade II injuries). Fifty patients (41 grade III and 9 grade IV injuries) were excluded. Heart rate (HR) and systolic blood pressure (SBP) targets were achieved with esmolol infusion (74%), nicardipine infusion (25%), vasopressor infusion (15%), intravenous antihypertensives as needed (25%), and oral antihypertensive therapy (42%). Median nonadherence time at target HR was 1 h (interquartile range [IQR]: 0-6), 2 h (IQR: 0-14), and 1 h (IQR: 0-6) in the first, second, and third 24-h intervals after admission, respectively. Median nonadherence time at target SBP was 4 h (IQR: 3-9), 7 h (IQR: 2-13), and 6 h (IQR: 1-16) in the first, second, and third 24-h intervals after admission, respectively. Percentage of time adherent to HR and SBP targets ranged from 88 to 98 and 64 to 94%, respectively. All patients with grade I BTAI tolerated initial medical management. Five patients (7%) with grade II BTAI, initially managed nonoperatively, subsequently underwent thoracic endovascular aortic repair.

Adherence to anti-impulse control therapy ranged from moderate to excellent in this cohort of patients and was associated with favorable outcomes in low-grade BTAI.