Trauma pneumonectomy for major thoracic bleeding: When should we consider about it?
Two very interesting articles presented in the Journal of Trauma and Acute Care Surgery recently focused on hemothorax after chest trauma. In their study, Dennis et al.1 demonstrated that the implementation of an evidence-based hemothorax algorithm reduced the number of patients requiring additional interventions without increasing complications rate. In their retrospective analysis of the National Trauma Data Bank, Matsushima et al.2 evaluated trauma patients who underwent pneumonectomy within the first 24 hours. With a very high mortality rate (overall mortality rate of 59.8% with a higher risk for blunt trauma [77.6%] compared with penetrating trauma [49.1%]), this procedure seems to be indicated and performed in very severe trauma cases. In the studied population, only a few patients underwent a first procedure (either wedge resection or lobectomy) before total pneumonectomy and pneumonectomy was performed within the first 6 hours after admission in 78.9% of all cases. Hence, pneumonectomy was rarely considered as a rescue procedure but more often as the initial damage control indicated procedure.
We recently had in our center a case with major blunt chest trauma with hemothorax and hemodynamic instability, leading, on the way to the operating theatre, to cardiac arrest. Although cardiopulmonary resuscitation was performed, a wedge resection was initially performed and led to a transient control of the bleeding (and to hemodynamic transient stability). However, a few hours later, the bleeding started again and led to a new cardiac arrest while the surgical team was preparing for a rescue procedure. A pneumonectomy was performed with ongoing cardiopulmonary resuscitation but could not save the patient.