Major thoracoabdominal cardiovascular injuries (TACVI) result in high mortality rates. Immediate access to critical care and increased availability of endovascular techniques may improve survival. This study reviews one community trauma center's experience with TACVI to determine if progression from Level II to Level I trauma center designation, and/or the introduction of endovascular repair techniques are related to improved mortality rates.
Patients with blunt or penetrating TACVIs [heart, thoracic aorta and major intrathoracic branches, abdominal aorta and major intraabdominal branches, iliac arteries, and major venous injuries (superior/ inferior vena cava, pulmonary arteries) were retrospectively reviewed from 12/01/1992 through 02/28/2009. Age, Injury Severity Score (ISS), length of hospital stay (LOS), gender, and associated injuries were recorded. Mortality rates were compared among four time periods: P1- time of Level II designation, 1992–1998; P2- Level I designation, pre-endograft era, 1998–2003; P3-Level I designation, endograft era, 2003–2009; and P4-total time of Level I designation, 1998–2009. Main outcome measured was mortality rate from TACVI.
274 patients with TACVIs (blunt-172,63%; penetrating-102,37%) were admitted: 6 (2.2%) with cardiac (mortality 1/6,17%), 103 (37.6%) with thoracic, and 165 (60.2%) with abdominal injuries. Mortality rates for P1 (Level II) versus (vs) P4 (Level I) was: all patients- 50% vs 30% (p = 0.002); thoracic- 70% vs 33% (p = 0.001); abdominal- 38% vs 29% (p = 0.275). Survival improved in the subgroup of thoracic aortic injury patients when P2 was compared to P1 [11/22, (50%) vs 15/17, (88%); p = 0.013] but not with P2 vs P3 [11/22, (50%) vs 7/25, (28%); p = 0.106]. No survival benefit was identified comparing P1, P2, and P3 for non-aortic major thoracic injuries.
In contrast to major abdominal and non-aortic thoracic vascular injuries, survival following thoracic aortic injuries improved when our facility changed from Level II to Level I status. The advent of endovascular aortic repair was not singularly associated with improved survival.
Changes in acute critical care management of major thoracic vascular injuries play an equal if not more important role in reducing mortality.
Scott Norwood, No Financial Disclosure Information; No Product/Research Disclosure Information