The journal of trauma and acute care surgery · 2026
One incision, complete access: Median sternotomy and aortic occlusion in penetrating chest trauma.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Ordoñez Carlos A, Serna José Julián, Parra Michael W, Gempeler Andrés, Fernández María Isabel, Montilla Diana, Barbosa Mario, Salcedo Alexander, Serna Carlos Andrés, Sánchez Boris, Franco María Josefa, Palacios Helmer, García Alberto F, Rodríguez-Holguín Fernando
Аннотация
BACKGROUND: We set out to evaluate outcomes of an innovative surgical approach that combines the use of a resuscitative median sternotomy and a descending aortic occlusion open (Ordoñez Maneuver) and/or endovascular for hemodynamically unstable patients suffering from penetrating chest trauma.
METHODS: We conducted a retrospective observational study at a Level I trauma center from 2018 to 2024. Eighty-two patients (older than 18 years) with severe penetrating chest trauma (Injury Severity Score, >15) who underwent an emergency median sternotomy with or without aortic occlusion were included. The primary outcome was mortality.
RESULTS: A total of 82 patients (93% male; median age, 27 years) underwent median sternotomy. The median Injury Severity Score was 25 with estimated blood loss of 3 L. Forty-eight patients (59%) underwent aortic occlusion: 23 (28%) via open cross-clamping and 25 (30%) via resuscitative endovascular balloon occlusion of the aorta. The median aortic occlusion time was 30 minutes. Thoracic vessel injuries occurred in 66% of patients, cardiac injuries in 29%, and lung injuries in 71%. Overall mortality was 27%. The expected mortality in the resuscitative median sternotomy (RMS) cohort was 34.15% (28 expected deaths), compared with 26.8% observed mortality (22 observed deaths; p = 0.32). Among the survivors, the median intensive care unit length of stay was 4 days, and the median hospital length of stay was 8 days.
CONCLUSION: A resuscitative median sternotomy in combination with an aortic occlusion (open and/or endovascular) is a feasible and versatile option for hemodynamically unstable patients with penetrating chest trauma. This approach offers access to both hemithoraces and mediastinal structures through a single incision without higher than expected mortality. Further validation from future prospective, comparative studies are necessary before broader recommendations can be made. ( J Trauma Acute Care Surg . 2026;100: 810-817. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).
LEVEL OF EVIDENCE: Therapeutic/Care Management; Level V.
METHODS: We conducted a retrospective observational study at a Level I trauma center from 2018 to 2024. Eighty-two patients (older than 18 years) with severe penetrating chest trauma (Injury Severity Score, >15) who underwent an emergency median sternotomy with or without aortic occlusion were included. The primary outcome was mortality.
RESULTS: A total of 82 patients (93% male; median age, 27 years) underwent median sternotomy. The median Injury Severity Score was 25 with estimated blood loss of 3 L. Forty-eight patients (59%) underwent aortic occlusion: 23 (28%) via open cross-clamping and 25 (30%) via resuscitative endovascular balloon occlusion of the aorta. The median aortic occlusion time was 30 minutes. Thoracic vessel injuries occurred in 66% of patients, cardiac injuries in 29%, and lung injuries in 71%. Overall mortality was 27%. The expected mortality in the resuscitative median sternotomy (RMS) cohort was 34.15% (28 expected deaths), compared with 26.8% observed mortality (22 observed deaths; p = 0.32). Among the survivors, the median intensive care unit length of stay was 4 days, and the median hospital length of stay was 8 days.
CONCLUSION: A resuscitative median sternotomy in combination with an aortic occlusion (open and/or endovascular) is a feasible and versatile option for hemodynamically unstable patients with penetrating chest trauma. This approach offers access to both hemithoraces and mediastinal structures through a single incision without higher than expected mortality. Further validation from future prospective, comparative studies are necessary before broader recommendations can be made. ( J Trauma Acute Care Surg . 2026;100: 810-817. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).
LEVEL OF EVIDENCE: Therapeutic/Care Management; Level V.