Outcome of Resuscitative Thoracotomy and Descending Aortic Occlusion Performed in the Operating Room

Abstract

Objectives of temporary descending thoracic aortic cross-clamping for exsanguinating abdominal hemorrhage are to redistribute intravascular volume to the myocardium and brain, and to limit further blood loss. This report describes our experience with left thoracotomy and descending aortic occlusion (T/AO) performed in the operating room (OR) for massive hemoperitoneum. During a 5-year period, 39 (5%) of 791 patients undergoing laparotomy for acute injury required T/AO in the OR. According to protocol, T/AO was undertaken before celiotomy if systolic blood pressure (SBP) remained <80 mm Hg despite full resuscitation (23 patients), and after celiotomy if SBP fell to <60 mm Hg with upper abdominal hemorrhage (16 patients). Mechanism of injury was gunshot wound in 21, stab injury in eight, and blunt trauma in ten. Twelve patients (31%) survived to leave the hospital. Seven of these individuals sustained hepatosplenic injuries, three had major vascular trauma, and the remaining two had combined injuries. Average SBP increased from 51 to 126 mm Hg following T/AO in the preceliotomy group, and from 48 to 131 mm Hg in post-celiotomy patients. The aorta was cross-clamped an average of 43 minutes in the preceliotomy patients, and 19 minutes in the post-celiotomy group. Six survivors (50%) developed major abdominal complications (rebleeding, fistulae, abscess, and pancreatitis). Only two patients, however, had pulmonary problems associated with T/AO; and both were minor (atelectasis and recurrent pneumothorax). In our experience, T/AO in the OR is successful in salvaging nearly one third of patients with life-threatening abdominal hemorrhage. The procedure can be performed rapidly, safely, and with minimal late sequelae.