Highlights
- •VATS could be applied to selected blunt trauma patients with massive haemothorax.
- •The major differences between the VATS and thoracotomy groups were coagulopathy, acidosis, PaO2/FiO2 ratio < 200 mmHg, or a persistent need for blood transfusion.
- •The conversion to thoracotomy rate of VATS for blunt trauma patients with massive haemothorax was 26% in the current study.
- •VATS took more time for anaesthesia and preparation.
Abstract
Introduction
The study reviewed the experience of video-assisted thoracoscopic surgery (VATS) for
the treatment of massive haemothorax (MHT).
Materials and Methods
All adult patients who sustained blunt trauma with a diagnosis of traumatic haemothorax
or pneumothorax (ICD9 860; ICD10 S27.0–2), injury to the heart and lungs (ICD9 861;
ICD10 S26, S27.3–9), and injury to the blood vessels of the thorax (ICD9 901; ICD10
S25) were queried from the trauma registry between 2014 and 2018. Patients who had
chest tube drainage amounts meeting the criteria for MHT and who underwent subsequent
operations were eligible for analyses. The patients were divided into VATS or thoracotomy
groups based on the surgical modalities. Descriptions and analyses of the two groups
were made.
Results
Thirty-eight patients were enroled in the study, including 8 females (21%) and 30
males. The median age was 47.0 (first quartile (Q1) 25.5 and third quartile (Q3) 59.3)
years. Twenty-three patients were in the VATS group, six (26%) of whom were converted
to thoracotomy. There were no obvious differences in age, sex, pulse rate, or systolic
pressure on arrival to the ED or after resuscitation between the two groups. The laboratory
data were worse amongst the thoracotomy group, especially the arterial blood gas analysis
(ABG) results: pH 7.2 (7.1, 7.3) vs. 7.4 (7.2, 7.4); HCO3 14.6 (12.4, 18.7) vs. 19.7 (16.1, 23.9) mEq/L; base excess (BE) -12.6 (-15.8, -7.8)
vs. -5.2 (-11.1, -0.9) mEq/L. The PaO2/FiO2 ratio was lower in the thoracotomy group (91.4 (68.5, 193.3) vs. 245.3 (95.7, 398.0)
mmHg). The thoracotomy group had coagulopathy (INR 1.6 (1.2, 1.9) vs. 1.3 (1.1, 1.4))
and required more blood transfusions (WB and PRBC 36.0 (16.0, 48.0) vs. 12.0 (4.0,
24.0) units; FFP 20.0 (6.0, 50.0) vs. 6.0 (2.0, 20.0) unit). No factors associated
with VATS conversion to thoracotomy could be identified.
Conclusions
VATS could be applied to selected blunt trauma patients with MHT. The major differences
between the VATS and thoracotomy groups were coagulopathy, acidosis, PaO2/FiO2 ratio < 200 mmHg, or a persistent need for blood transfusion.
Keywords
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Article info
Publication history
Published online: August 13, 2022
Accepted:
August 11,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
