Damage control thoracotomy trends, techniques, and outcomes: An EAST multicenter trial.

Authors

Anthony D Douglas, Teddy Puzio, Partick Murphy, Jeffry Nahmias, Nikolay Bugaev, Haytham Kaafarani, Leah Tatebe, Bryce Robinson, Matthew Carrick, Jordan Finch, Harrison Smith, Leah Hoefer, Robert Keskey, Andrew Snyder, Madison J LeClair, David Turay, Gerald Wang, Gweniviere Capron, Dillon Cheung, Atli Valgardsson, Brittany Bankhead, Anna Liveris, John Taylor, Dominic Cromer, Anna Goldenberg-Sandau, Taylor Powers, Asanthi Ratnasekera, Sirivan Seng, Juan Figueroa, Francesk Mulita, Georgios I Panagiotopoulos, Juan Ramos, Liz Villalobos, Nicole Frederick, Lauren Favors, Robert Maxwell, Chance Spalding, Anna Kurian, Kimberly Sperwer, Lara Senekijan, Anthony Gebran, Rachel Burke, Satya Dalavayi, Gillian Hoshal, Christine Cocanour, Grace Chang, Ashley Meagher

Published in

The journal of trauma and acute care surgery. May 28, 2025. Epub May 28, 2025.

Abstract

Damage-control thoracotomy (DCT) lacks evidence regarding frequency of use, optimal technique, and outcomes. This Eastern Association for the Surgery of Trauma multicenter trial aimed to examine DCT usage over the last decade, evaluate types of temporary closure, and assess associated outcomes.
An international retrospective cohort study of thoracotomies from 2008 to 2020 at 25 centers was performed. Patients age 16 years or older undergoing thoracotomy within 24 hours of admission who survived to intensive care unit (ICU) admission were included. Mixed logistic regression was used to assess complications associated with closure type, trends in DCT utilization, and mortality. Competing risk regression model was used to determine trends in ICU-free days for DCT over time.
Nine hundred twenty-two thoracotomy operations were performed, of those 402 (44%) were DCT. Most injuries were penetrating (n = 609, 66%) and the most common mechanism was gunshot wound. Damage-control thoracotomy patients were significantly more injured and ill on presentation. Fifty-four percent of DCT began in the emergency department. Most common temporary closure types included skin only (n = 103, 25%), commercial vacuum device (n = 123,30%), and adhesive dressing (n = 129, 32%). Frequent complications following DCT were pneumonia (n = 57, 14%), acute renal failure (n = 53,13%), and sepsis (n = 41, 10%). Mortality rate in the DCT group was 61%, versus 17% for definitive thoracotomy (n < 0.001). Utilization of DCT has increased in a linear fashion during the study period, as well as ICU-free days out of 30 (odds ratio, 1.66; 95% confidence interval, 1.18-2.33); however, mortality has not changed over time (odds ratio, 0.61; 95% confidence interval, 0.22-1.98). After mixed logistic regression, there was no difference in complications based on closure type.
The use of DCT is increasing over time with improved ICU-free days, but without improved mortality. Mechanism of temporary closure should be determined based on operator's experience and institutional resources.
Retrospective Cohort Study; Level III.

PMID:
40435348
Bibliographic data and abstract were imported from PubMed on 29 May 2025.

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