Trauma Pneumonectomy: Has Survival Improved Over Two Decades?

IntroductionThe hypothesis of this study is that recent advances in mechanical cardiopulmonary support and operative management have improved survival in patients requiring a trauma pneumonectomy.MethodsRetrospective, single center study from January 2003 to December 2023 of all patients who underwent a pneumonectomy for trauma. Data collected included demographics, admission physiology, use of venovenous extracorporeal membrane oxygenation (VV-ECMO), and mortality, defined as early (within 24 hours of surgery) and late (>24 hours after surgery). Outcomes were compared between decades, the first decade (2003-2010) and second decade (2011-2023).ResultsTwenty patients met inclusion criteria, 9 in the first decade and 11 in the second decade. There were no differences in Injury Severity Score (ISS) (26.4 vs 34.3, P = 0.23). However, those in the second decade had significantly lower mean admission pH (6.89 vs 7.14, P = 0.01) and higher admission base deficit (19.3 vs 9.8, P = 0.003). The use of thoracic damage control surgery increased from 33% in the first decade to 100% in the second decade (P = 0.002). VV-ECMO with lung rest ventilation increased from 22% to 64% (P = 0.06). Overall and early mortality did not change (55.6% vs 45.5%, p-0.65 and 11% vs 36.3%, P = 0.09, respectively). However, late mortality was dramatically lower in the second decade compared to the first (9% vs 50%, P = 0.06).ConclusionEarly mortality remains high; however, the combination of thoracic damage control and early initiation of VV-ECMO may contribute to the dramatic decrease in late mortality in the second decade.