Surgical management of penetrating thoracic injuries during the Paris attacks on 13 November 2015

Boddaert, Guillaume; Mordant, Pierre; Pimpec-Barthes, Françoise Le; Martinod, Emmanuel; Aguir, Sonia; Leprince, Pascal; Raux, Mathieu; Couëtil, Jean‐Paul; Fiore, Antonio; Lescot, Thomas; Malgras, Brice; Pons, François; Castier, Yves

doi:10.1093/ejcts/ezx036

Cited by 13 publications

(15 citation statements)

References 21 publications

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“…Emerging ignorance (hubris of omnipotence) of physiologic limits of patient in extreme was only half of the reasons calling for a mindset change. Accumulated military surgical experiences in asymmetric warfare (3) and changing injury profiles in new types of violence (4) were to be applied in care of terror attack victims (5,6). An increasing number of civilian surgeons had to face mass casualty situations (7,8) challenging received wisdom and well established protocols developed in decades of peace (9).…”

Section: Introductionmentioning

confidence: 99%

Thoracic damage control surgery

Molnár

2019

J. Thorac. Dis

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Thoracic damage control surgery (TDCS) is a decision making tool and derivate of the damage control concept (DCC), where physiological stabilization has a priority over anatomical reconstruction under the pressure of time. Intrathoracic haemorrhage control and pleural decompression are the two main immediate tasks of TDCS, while definitive procedures follow when the patient is stabilised in 24-48 hours. The focus of the thoracic surgeon is on the prevention of the haemorrhage induced coagulopathy, metabolic acidosis and hypothermy formed triad of death. Surgical haemorrhage control and pleural space decompression are to be performed. The individual patients benefit from TDCS procedures whose condition is too severe for a complex immediate reconstruction (polytrauma). Life threatening chest injuries in multiple/mass casualty scenarios in civilian and military environment alike are triaged and treated accordingly. Onset of acute mismatch between the resources (available hands, OP theaters, resources, hardware) and the needs (number and severity of chest trauma cases), a mindset shift should take place, where time and space the two main limiting factors. Airway obstruction, tension haemo/pneumothorax falls into the preventable death category. Chest drainage and emergency thoracotomy are the two main procedures offered by TDCS. An intervention structured organ/injury specific list of procedures is detailed. This is a mix of emergency surgery and cardiothoracic surgery, where less is more. TDSC is not the Holy Grail found to solve all complex thoracic trauma cases, but is a good tool to increase the chance for survival in challenging, and frequently quite hopeless situations.

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Section: Introductionmentioning

confidence: 99%

Thoracic damage control surgery

Molnár

2019

J. Thorac. Dis

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“…В современном мире отмечается постоянное увеличение числа локальных вооруженных войн и контртеррористических операций, а также терро ристических актов в решении межэтнических, ре лигиозных, политических конфликтов, которые со провождаются большим числом пострадавших от огнестрельных ранений [1][2][3][4][5].…”

Section: Introductionunclassified

“…На этапах оказания специализированной хирур гической помощи при стабильной гемодинамике ра неных, при нарастании внутриплеврального крово течения, необходимо проводить лучевые методы диагностики для выявления источника кровотечения (ультразвуковую допплерографию, мультисрезовую компьютерную ангиографию (МСКТ), селективную ангиографию) [2][3][4]. Динамическое контрольное лучевое обследование может выполняться в рамках «damadge contro 1», когда результаты исследований сомнительные, «пограничные», когда дальнейшая хирургическая тактика еще не определена [1,4].…”

Section: Introductionunclassified

Multidetector computed tomography in the diagnosis of lesions of the main vessels for gunshot injury of the chest

Васильев

Обельчак

2019

Regional blood circulation and microcirculation

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Purpose – examine the possibilities of multislice computed tomangiography (MSCTA) in case of suspected damage to the great vessels in a chest gunshot fghting injury.Material and methods. A radiation survey of 130 wounded with gunshot injuries of the chest to assess the nature, diagnosis of gunshot injuries of the vascular bed.Results. Of the 130 wounded with gunshot wounds to the chest, 41 (31.5 %) of the injured had gunshot wounds to the chest were nonpenetrating, and 89 (68.5 %) had penetrating injuries. In 76 (58.4 %) patients with gunshot chest injuries, the nature of the wound was fragmentation, in 54 (41.6 %), wounds were bullet wounds. In the algorithm of radiation examination of patients with gunshot wounds of the chest to identify the nature of damage to the organs of the mediastinum and vascular structures, the main method of visualization was MSCT with contrast enhancement. Damage to the bone skeleton of the chest (ribs, collarbone, sternum, scapula) by MSCT was observed in 23 (17.6 %) patients. Almost half – 66 (50.1 %) of the wounded with gunshot injuries during MSCT examination, traumatic injury (pulmonitis) of the lung was observed. In 2 (1.5 %) cases, damage to the heart was detected that was not recognized at the stage of skilled surgical care. False posttraumatic aneurysm of the thoracic aorta was diagnosed in two wounded. Accuracy, sensitivity, specifcity of MSCT angiography in imaging of the vascular bed and diagnosis of damage to the great vessels of the chest cavity was 98, 97 and 97 %, respectively.Conclusions. MSCT made it possible to reliably assess the nature of the gunshot injuries of the chest, identify timely damage to the great vessels of the mediastinum, determine the localization of the foreign injuring bodies near the vascular structures, and determine the surgical tactics.

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“…Dans la série hollandaise de Heus et al s'intéressant particulièrement aux TTP, 73% des plaies étaient par armes blanches et 21% par armes à feu (50).Les lésions par armes de guerre se rencontrent également en milieu civil. En effet, la population civile est exposée aux risques d'attentats par explosion ou par armes à feu, comme nous le rappellent les évènements français que nous gardons en mémoire depuis 2015 à Paris.La typologie et la gravité des lésions dans ce cas diffèrent de celles des blessés au combat par l'absence de port d'effets protecteurs, ce qui est un élément aggravant et ce qui place le thorax comme une zone particulièrement exposée au traumatisme pénétrant(87).…”

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“…Our observation period analyses the soldiers serving during Operation Pamir in Afghanistan, up to the beginning of Operation Barkhane in the Sahelo-Saharan band, thus explaining the mixed injury profile of injured soldiers. Over a 10-year period in Iraq, about 75% of fatal injuries were caused by an explosion and about 20% by a GSW(12,87). In civilian patients, the profile is reversed, with 63% of patients suffering from SW, 29% from GSW and 8% from shrapnel.The injury mechanisms were comparable to the European civil literature where the majority of wounds follow a stab wound(3,109).…”

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confidence: 99%

Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre

et al. 2019

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BackgroundPenetrating thoracic injuries (PTIs) is a medicosurgical challenge for civilian and military trauma teams. In civilian European practice, PTIs are most likely due to stab wounds and mostly require a simple chest tube drainage. On the battlefield, combat casualties suffer severe injuries, caused by high-lethality wounding agents.The aim of this study was to analyse and compare the demographics, injury patterns, surgical management and clinical outcomes of civilian and military patients with PTIs.MethodsAll patients with PTIs admitted to a Level I Trauma Centre in France or to Role-2 facilities in war theatres between 1 January 2004 and 31 May 2016 were included. Combat casualties’ data were analysed from Role-2 medical charts. The hospital manages military casualties evacuated from war theatres who had already received primary surgical care, but also civilian patients issued from the Paris area. During the study period, French soldiers were deployed in Afghanistan, in West Africa and in the Sahelo-Saharan band since 2013.Results52 civilian and 17 military patients were included. Main mechanisms of injury were stab wounds for civilian patients, and gunshot wounds and explosive fragments for military casualties. Military patients suffered more severe injuries and needed more thoracotomies. In total, 29 (33%) patients were unstable or in cardiac arrest on admission. Thoracic surgery was performed in 38 (55%) patients (25 thoracotomies and 13 thoracoscopies). Intrahospital mortality was 18.8%.ConclusionWar PTIs are associated with extrathoracic injuries and higher mortality than PTIs in the French civilian area. In order to reduce the mortality of PTIs in combat, our study highlights the need to improve tactical en route care with transfusion capabilities and the deployment of forward surgical units closer to the combatants. In the civilian area, our results indicated that video-assisted thoracoscopic surgery is a reliable diagnostic and therapeutic technique for haemodynamically stable patients.

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Surgical management of penetrating thoracic injuries during the Paris attacks on 13 November 2015

Cited by 13 publications

References 21 publications

Thoracic damage control surgery

Thoracic damage control surgery

Multidetector computed tomography in the diagnosis of lesions of the main vessels for gunshot injury of the chest

Penetrating thoracic injuries: a retrospective analysis from a French military trauma centre

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