Central XXXX : a need for early vascular control.

@entity1 @entity548 @entity190 @entity651 @entity1167 @entity204 @entity130
During a 7-year period (1980-1987), 161 @entity1 underwent emergency thoracotomy for penetrating @entity651 . Of these, 25 (15%) had @entity130 involving central pulmonary (hilar) vascular structures. Anterolateral thoracotomies were performed in 14 @entity1 because of unstable vital signs (ten) or @entity1167 (four), and only two (14%) of these @entity1 survived. In seven of these @entity1 the incision was extended into a bilateral thoracotomy to provide better exposure for continued severe @entity548 , and all seven died. Of 11 relatively stable @entity1 having a posterolateral incision (ten) or a median sternotomy (one), only two (18%) died. Of 18 @entity1 in whom the initial procedure was hilar clamping, ten (63%) survived. In seven @entity1 an attempt was made to control the @entity548 before hilar clamping and only one (14%) survived. In six @entity1 , resection of a lobe (five) or a segment (one) was used to achieve hemostasis with five (83%) survivors. Eight of the 14 @entity204 were clearly due to @entity190 , which was treated with an average of 19.5 units of blood. However, in six of the earlier @entity204 with much less @entity190 , air emboli may have been a factor, but was unproven. Early vascular control at the hilum for central @entity651 seems to be needed not only to stop the @entity548 but also to prevent systemic air emboli.
