Prospective Study of Blunt Aortic Injury: Multicenter Trial of the American Association for the Surgery of Trauma

Timothy Fabian; J. David Richardson; Martin A. Croce; J. Stanley Smith; George J. Rodman; Paul A. Kearney; William Flynn; Arthur L. Ney; John B. Cone; Fred A. Luchette; David H. Wisner; Donald J. Scholten; Bonnie L. Beaver; Alasdair K. Conn; Robert Coscia; David B. Hoyt; John A. Morris; J. Duncan Harviel; Andrew B. Peitzman; Raymond P. Bynoe; Daniel L. Diamond; Matthew Wall; Jonathan D. Gates; Juan A. Asensio; Mary C. McCarthy; Murray J. Girotti; Mary VanWijngaarden; Thomas H. Cogbill; Marc A. Levison; Charles Aprahamian; John E. Sutton; C. F. Allen; Erwin F. Hirsch; Kimberly Nagy; Ben L. Bachulis; Charles R. Bales; Marc J. Shapiro; Michael H. Metzler; Vincent R. Conti; Christopher C. Baker; Michael P. Bannon; Gage M. Ochsner; Michael H. Thomason; Jonathan R. Hiatt; Keith O'Malley; Farouck N. Obeid; Perry Gray; Paul E. Bankey; M. Margaret Knudson; Donna Lynn Dyess; Blaine L. Enderson

Prospective Study of Blunt Aortic Injury: Multicenter Trial of the American Association for the Surgery of Trauma

Timothy Fabian, J. David Richardson, Martin A. Croce, J. Stanley Smith, George J. Rodman, Paul A. Kearney, William Flynn, Arthur L. Ney, John B. Cone, Fred A. Luchette, David H. Wisner, Donald J. Scholten, Bonnie L. Beaver, Alasdair K. Conn, Robert Coscia, David B. Hoyt, John A. Morris, J. Duncan Harviel, Andrew B. Peitzman, Raymond P. BynoeDaniel L. Diamond, Matthew Wall, Jonathan D. Gates, Juan A. Asensio, Mary C. McCarthy, Murray J. Girotti, Mary VanWijngaarden, Thomas H. Cogbill, Marc A. Levison, Charles Aprahamian, John E. Sutton, C. F. Allen, Erwin F. Hirsch, Kimberly Nagy, Ben L. Bachulis, Charles R. Bales, Marc J. Shapiro, Michael H. Metzler, Vincent R. Conti, Christopher C. Baker, Michael P. Bannon, Gage M. Ochsner, Michael H. Thomason, Jonathan R. Hiatt, Keith O'Malley, Farouck N. Obeid, Perry Gray, Paul E. Bankey, M. Margaret Knudson, Donna Lynn Dyess, Blaine L. Enderson

Wright State University

Research output: Contribution to journal › Article › peer-review

Abstract

<p> Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. <h4> METHODS: </h4></p><p> This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma. <h4> RESULTS: </h4></p><p> There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of > or = 30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. <h4> CONCLUSIONS: </h4></p><p> Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.</p>

Original language	American English
Journal	The Journal of Trauma: Injury, Infection, and Critical Care
Volume	42
State	Published - Mar 1 1997

Keywords

Blunt Aortic Injury
Management

Disciplines

Medical Specialties
Medicine and Health Sciences
Surgery

Cite this

Fabian, T., Richardson, J. D., Croce, M. A., Smith, J. S., Rodman, G. J., Kearney, P. A., Flynn, W., Ney, A. L., Cone, J. B., Luchette, F. A., Wisner, D. H., Scholten, D. J., Beaver, B. L., Conn, A. K., Coscia, R., Hoyt, D. B., Morris, J. A., Harviel, J. D., Peitzman, A. B., ... Enderson, B. L. (1997). Prospective Study of Blunt Aortic Injury: Multicenter Trial of the American Association for the Surgery of Trauma. The Journal of Trauma: Injury, Infection, and Critical Care, 42.

Fabian, T, Richardson, JD, Croce, MA, Smith, JS, Rodman, GJ, Kearney, PA, Flynn, W, Ney, AL, Cone, JB, Luchette, FA, Wisner, DH, Scholten, DJ, Beaver, BL, Conn, AK, Coscia, R, Hoyt, DB, Morris, JA, Harviel, JD, Peitzman, AB, Bynoe, RP, Diamond, DL, Wall, M, Gates, JD, Asensio, JA, McCarthy, MC, Girotti, MJ, VanWijngaarden, M, Cogbill, TH, Levison, MA, Aprahamian, C, Sutton, JE, Allen, CF, Hirsch, EF, Nagy, K, Bachulis, BL, Bales, CR, Shapiro, MJ, Metzler, MH, Conti, VR, Baker, CC, Bannon, MP, Ochsner, GM, Thomason, MH, Hiatt, JR, O'Malley, K, Obeid, FN, Gray, P, Bankey, PE, Knudson, MM, Dyess, DL & Enderson, BL 1997, 'Prospective Study of Blunt Aortic Injury: Multicenter Trial of the American Association for the Surgery of Trauma', The Journal of Trauma: Injury, Infection, and Critical Care, vol. 42.

@article{ad0ae40f1fcf4f438beb3e45b7ab943a,

title = "Prospective Study of Blunt Aortic Injury: Multicenter Trial of the American Association for the Surgery of Trauma",

abstract = " Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. METHODS: This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma. RESULTS: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of > or = 30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. CONCLUSIONS: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.",

keywords = "Blunt Aortic Injury, Management",

author = "Timothy Fabian and Richardson, {J. David} and Croce, {Martin A.} and Smith, {J. Stanley} and Rodman, {George J.} and Kearney, {Paul A.} and William Flynn and Ney, {Arthur L.} and Cone, {John B.} and Luchette, {Fred A.} and Wisner, {David H.} and Scholten, {Donald J.} and Beaver, {Bonnie L.} and Conn, {Alasdair K.} and Robert Coscia and Hoyt, {David B.} and Morris, {John A.} and Harviel, {J. Duncan} and Peitzman, {Andrew B.} and Bynoe, {Raymond P.} and Diamond, {Daniel L.} and Matthew Wall and Gates, {Jonathan D.} and Asensio, {Juan A.} and McCarthy, {Mary C.} and Girotti, {Murray J.} and Mary VanWijngaarden and Cogbill, {Thomas H.} and Levison, {Marc A.} and Charles Aprahamian and Sutton, {John E.} and Allen, {C. F.} and Hirsch, {Erwin F.} and Kimberly Nagy and Bachulis, {Ben L.} and Bales, {Charles R.} and Shapiro, {Marc J.} and Metzler, {Michael H.} and Conti, {Vincent R.} and Baker, {Christopher C.} and Bannon, {Michael P.} and Ochsner, {Gage M.} and Thomason, {Michael H.} and Hiatt, {Jonathan R.} and Keith O'Malley and Obeid, {Farouck N.} and Perry Gray and Bankey, {Paul E.} and Knudson, {M. Margaret} and Dyess, {Donna Lynn} and Enderson, {Blaine L.}",

year = "1997",

month = mar,

day = "1",

language = "American English",

volume = "42",

journal = "The Journal of Trauma: Injury, Infection, and Critical Care",

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TY - JOUR

T1 - Prospective Study of Blunt Aortic Injury: Multicenter Trial of the American Association for the Surgery of Trauma

AU - Fabian, Timothy

AU - Richardson, J. David

AU - Croce, Martin A.

AU - Smith, J. Stanley

AU - Rodman, George J.

AU - Kearney, Paul A.

AU - Flynn, William

AU - Ney, Arthur L.

AU - Cone, John B.

AU - Luchette, Fred A.

AU - Wisner, David H.

AU - Scholten, Donald J.

AU - Beaver, Bonnie L.

AU - Conn, Alasdair K.

AU - Coscia, Robert

AU - Hoyt, David B.

AU - Morris, John A.

AU - Harviel, J. Duncan

AU - Peitzman, Andrew B.

AU - Bynoe, Raymond P.

AU - Diamond, Daniel L.

AU - Wall, Matthew

AU - Gates, Jonathan D.

AU - Asensio, Juan A.

AU - McCarthy, Mary C.

AU - Girotti, Murray J.

AU - VanWijngaarden, Mary

AU - Cogbill, Thomas H.

AU - Levison, Marc A.

AU - Aprahamian, Charles

AU - Sutton, John E.

AU - Allen, C. F.

AU - Hirsch, Erwin F.

AU - Nagy, Kimberly

AU - Bachulis, Ben L.

AU - Bales, Charles R.

AU - Shapiro, Marc J.

AU - Metzler, Michael H.

AU - Conti, Vincent R.

AU - Baker, Christopher C.

AU - Bannon, Michael P.

AU - Ochsner, Gage M.

AU - Thomason, Michael H.

AU - Hiatt, Jonathan R.

AU - O'Malley, Keith

AU - Obeid, Farouck N.

AU - Gray, Perry

AU - Bankey, Paul E.

AU - Knudson, M. Margaret

AU - Dyess, Donna Lynn

AU - Enderson, Blaine L.

PY - 1997/3/1

Y1 - 1997/3/1

N2 - Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. METHODS: This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma. RESULTS: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of > or = 30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. CONCLUSIONS: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.

AB - Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. METHODS: This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma. RESULTS: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of > or = 30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. CONCLUSIONS: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.

KW - Blunt Aortic Injury

KW - Management

UR - https://corescholar.libraries.wright.edu/surg/559

M3 - Article

VL - 42

JO - The Journal of Trauma: Injury, Infection, and Critical Care

JF - The Journal of Trauma: Injury, Infection, and Critical Care

ER -

Prospective Study of Blunt Aortic Injury: Multicenter Trial of the American Association for the Surgery of Trauma

Abstract

Keywords

Disciplines

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