Atrial-caval shunting (ACS) after trauma

Area of Science:

• Trauma Surgery
• Surgical Critical Care
• Hemorrhage Control

Background:

• Massive hemorrhage from the inferior vena cava, hepatic veins, or liver poses a significant challenge in trauma care.
• The atrial-caval shunt (ACS) with porta hepatis inflow occlusion has been employed to manage such life-threatening bleeding.

Purpose of the Study:

• To evaluate the efficacy and outcomes of using the atrial-caval shunt (ACS) in managing massive hemorrhage in trauma patients.
• To identify factors associated with survival in patients undergoing ACS for severe abdominal vascular and hepatic injuries.

Main Methods:

• Retrospective review of 18 trauma patients treated with ACS and inflow occlusion at San Francisco General Hospital since 1968.
• Analysis of patient demographics, injury types, hemodynamic status (blood pressure), and associated injuries in relation to survival.

Main Results:

• Overall survival was low, with only 5 of 18 patients surviving the initial injury.
• Patients with blunt trauma and cardiac arrest, or initial systolic blood pressure <70 mm Hg post-resuscitation, had significantly lower survival rates.
• Survival varied by injury type: 1/7 for caval injuries, 2/4 for hepatic fractures, and 2/7 for combined injuries. Survivors had a higher average number of associated injuries.

Conclusions:

• The atrial-caval shunt (ACS) can be a life-saving measure for controlling massive hemorrhage in specific trauma scenarios.
• Patient's initial hemodynamic status and injury mechanism (blunt vs. penetrating) are critical determinants of survival following ACS.
• Further research is needed to optimize patient selection and management strategies to improve outcomes in severe abdominal vascular and hepatic trauma.