SURVIVAL AFTER TRAUMA PNEUMONECTOMY - THE PATHOPHYSIOLOGIC BALANCE OFSHOCK RESUSCITATION WITH RIGHT HEART-FAILURE

Emergency pneumonectomy for trauma has a high mortality. Although exsa nguination is a major factor leading to death, mortality remains high even after adequate resuscitation and is thought to be related to pulm onary edema and right heart failure. We present a series of nine patie nts who underwent pneumonectomy at Harbor-UCLA from penetrating (7) an d blunt (2) trauma. Two patients survived; three initially survived th e surgery but died postoperatively of hypoxemia and right heart failur e; four died intraoperatively (2 from right heart failure and 2 from e xsanguination). One survivor required open cardiac massage for asystol e. Careful attention to prevent volume overloading before and during t rauma pneumonectomy and maintaining a negative fluid balance postopera tively may contribute to survival in these patients.