This study analyses the outcome of patients with massive hemoptysis without response to conservative treatment and requiring emergency thoracotomy for hemostasis.
Between 1990 and 2005 we performed emergency thoracotomy with lung resection in 4 patients with life-threatening hemoptysis with no response to conservative treatment. Etiology was tuberculosis in all patients, one being with an anaerobic overinfection and one with atypical mycobacteria. The procedures performed were: lobectomy - 2 cases (one with simultaneous artery-bronchus stapling in a patient with 2 intraoperative cardiac arrests), pneumonectomy - 1 case and one non-anatomic resection with lateral suture of a pulmonary artery branch.
In all cases we achieved good hemostasis with no postoperative bleeding. We encountered a high rate of peri-operative complications: one patient with 2 intraoperative cardiac arrests, 3 patients with postoperatve pneumonia and one postoperative death in a patient with pneumonectomy performed after 2 cardiac arrests resuscitated in another unit. Only one patient had an uneventful postoperative course.
Emergency thoracotomy and resection for massive hemoptysis has a high morbidity and mortality, especially when other complications occur (such as tracheo-bronchial innundation, acute anemia or cardio-respiratory arrest). It should be reserved as a life-saving procedure when other conservative treatments are ineffective or unavailable.
Treatment of massive hemoptysis should be early and aggressive. If conservative treatment (hemostatic drugs, bronchoscopic hemostasis, embolisation) fail, the thoracic surgeon should be called immediately. Surgery gives good results if resection is performed in patients with stable hemodinamic and respiratory status, before development of other severe complications.
Alexandru Botianu, None.