Packing of the thoracic cavity – Damage control surgery for severe intra thoracic haemorrhage

Abstract

Background

Severe, uncontrollable intra thoracic haemorrhage is a life threatening situation for the patient in extremis and a challenge for the surgeon. Due to bleeding several serious pathophysiological changes occur in the organism. In addition to the threat of exsanguination itself, a “lethal triad” of acidosis, hypothermia and coagulopathy drive the patient into a hazardous situation.

Methods

In our prospective single centre study we present 19 patients with major bleeding aged 17 to 74 years (mean 48.36 years.).

Results

After successful packing the bleeding control was 100 % and no reoperation for bleeding was needed. There were two patients after trauma where the operation procedure came too late for successful packing. We observed a 5-day-mortality rate of 15.8 % (3 out of 19) and a 30-day-mortality rate of 31.2 % (5 out of 16). The overall mortality rate was 42.1 % (8 out of 19).

Conclusions

Damage control surgery (DCS) can save patients in extremis in spite of their serious condition. Thoracic packing as a DC procedure in patients with uncontrollable haemorrhage has only been published in a small series of patients or case reports over the last 30 years. In almost all case reports and publications, only patients with traumatic thoracic haemorrhage were treated by thoracic packing.