Abstract

PEREZ CANTU-SACAL, Alberto; TRUEBA-LOZANO, Demian; ROLAND DE RUNGS-BROWN, David  and  VAZQUEZ-MINERO, Juan Carlos. Transmediastinal Injury: A literature review and a visión of what needs to be done. Neumol. cir. torax [online]. 2015, vol.74, n.2, pp.95-101. ISSN 0028-3746.

Introduction: Transmediastinal trauma has been an important cause of admission to emergency rooms, specially recently, due to improvements in pre-hospital care and the new "scoop and run" protocols have reflected in even more patients that arrive alive and with hemodynamic stability (44-53%). Objective: We intend to review series of patients all over the world with transmediastinal trauma so we can demonstrate the situations that doctors and surgeons in the emergency rooms endure. We present a problem of this sort and questions that every physician should answer when diagnosing and treating transmediastinal injuries with a review of the most representative cases of this subject to gain a wide optic when resolving problems in trauma patients. Material and methods: We conducted a search in PubMed with MESH interlinked words "transmediastinal trauma", "transmediastinal injury", "transmediastinal gunshot" for a systematical review of the literature. We included articles in English, Spanish and French, only original texts from the last 35 years, together with highly cited publications that seemed necessary for full understanding. Moreover, we included several sets of guidelines to respond the questions we present. Results: A total of 15 original articles were taken into consideration, published between 1981 and 2013, all of them with level III of evidence according to the United States Agency for Health Research Quality; 8 articles were patient reviews, from which 3 were prospective studies thus giving us the chance to evaluate mortality and analyze diagnostic and therapeutic success in order to arrive to an informed conclusion about the best way to handle transmediastinal injuries. Discussion and conclusions: After a careful analysis of the aforementioned reviews, 602 patients with transmediastinal trauma were studied, 46.8% arrived to the emergency department with clinical hemodynamic stability, 53.1% presented with instability and 25% of them were submitted to an emergency department thoracotomy, 51.4 were transferred to an operating room for emergent surgery with an overall mortality of 41.6% which means that almost 1 out of every 2 patients with transmediastinal trauma eventually dies. Transmediastinal injuries may seem overwhelming every time, never the less, an organized and logical diagnostic approach will spare patients from unnecessary surgeries and untreated occult lesions. Furthermore we consider that every emergency room physician that encounters with transmediastinal trauma should ask himself the same questions we present in this review, this way we will be able to adequately treat and ultimately discharge patients free from complications.

Keywords : Transmediastinal trauma; transmediastinal injury; transmediastinal gunshot.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )