Occult ascending aortic rupture in the presence of an air bag

doi:10.1016/0003-4975(96)00367-0

The Annals of Thoracic Surgery

Volume 62, Issue 2, August 1996, Pages 577-578

https://doi.org/10.1016/0003-4975(96)00367-0 Get rights and content

A patient presented to the emergency department after a high-speed decelerating-type motor vehicle accident. Due to activation of his air bag device, the patient was without significant obvious injury. Upon evaluation in the emergency department he was also without any radiographic or physical signs of serious injury. In the ensuing 24 hours, severe chest pain developed, and subsequent aortography demonstrated a tear of his ascending aorta just distal to the root. Although occult injury to the aorta and great vessels does occur in a small percentage of patients, it is quite rare. However, with the advent of air bags, in the absence of associated injuries, signs, and symptoms, a high index of suspicion must be entertained in decelerating-type accidents to diagnose occult injury to the aorta and great vessels.

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Cited by (30)

Next-Generation Airbags and the Possibility of Negative Outcomes Due to Thoracic Injury
2014, Canadian Journal of Cardiology
Airbags have been shown to decrease morbidity and mortality associated with motor vehicle accidents when used in conjunction with seat belts. Airbag deployment alone however, has recently been implicated as a cause of significant thoracic injuries to unrestrained drivers. Resulting injuries include major cardiovascular and pulmonary complications. Airbags provide safety to occupants of cars and reduce mortality by 25%-30%. When not used in accordance with international standards, however, they can cause serious injury. We searched online databases from 1970 to January 2013 and included 17 retrospective studies, 12 systematic review articles, 18 case reports, 5 prospective studies, 1 lab study, 3 cohort studies, and 1 meta-analysis. Outcomes included clinical/functional response, left ventricular remodelling, hospitalizations, and mortality. Physicians must maintain a high index of suspicion for injury when evaluating drivers who were not wearing seat belts when airbags deployed, regardless of the speed of the collision, because increased risk of thoracic injury with airbags has been described in the literature. Our review indicates that even new technology, specifically the side air bag, has been associated with a risk of thoracic injury. Considering that regulations are a driving force for airbag technology, further research and scrutiny by medical teams is needed to consider the effects of airbag technology advancements on morbidity and mortality rates of car accidents, to help in guiding further improvement, and to help lawmakers in implementing rules that protect the safety of occupants.
Il a été démontré que les coussins gonflables diminuent la morbidité et la mortalité associées aux accidents d’automobile lorsqu’ils sont utilisés conjointement aux ceintures de sécurité. Cependant, le seul déploiement du coussin gonflable a récemment été reconnu comme ayant causé des blessures thoraciques importantes aux conducteurs qui ne bouclaient pas leur ceinture. Les blessures subies comprennent des complications cardiovasculaires et pulmonaires importantes. Les coussins gonflables assurent la sécurité des occupants des voitures et réduisent la mortalité de 25 % à 30 %. Cependant, lorsqu’ils ne sont pas utilisés selon les normes internationales, ils peuvent causer des blessures sérieuses. Nous avons cherché des bases de données en ligne allant de 1970 à janvier 2013 et avons inclus 17 études rétrospectives, 12 articles de revues systématiques, 18 observations, 5 études prospectives, 1 étude de laboratoire, 3 études de cohorte et 1 méta-analyse. Les résultats incluaient la réponse clinique et la réponse fonctionnelle, le remodelage ventriculaire gauche, les hospitalisations et la mortalité. Les médecins doivent maintenir un indice élevé de suspicion de blessures lorsqu’ils évaluent des conducteurs qui ne portaient pas leur ceinture lors du déploiement des coussins gonflables, quelle que soit la vitesse au moment de la collision, puisque l’augmentation du risque de blessures thoraciques liées aux coussins gonflables a été décrite dans la littérature. Notre revue indique que même la nouvelle technologie, particulièrement les coussins gonflables latéraux, a été associée à un risque de blessures thoraciques. Considérant que la réglementation est le principal moteur de la technologie liée aux coussins gonflables, d’autres recherches et études minutieuses doivent être réalisées par les équipes médicales pour examiner les effets des avancées technologiques en matière de coussins gonflables sur les taux de morbidité et de mortalité liés aux accidents de voiture afin de contribuer à l’orientation des nouvelles améliorations et d’aider les législateurs à mettre en place des règlements qui protègent la sécurité des occupants.
Sodium azide-associated laryngospasm after air bag deployment
2010, Journal of Emergency Medicine
Citation Excerpt :
Although designed to mitigate head and truncal injuries in high-speed motor vehicle collisions, air bag deployment is not risk free. The mechanical force generated in deployment (approximately 40–191 joules) has been implicated in ophthalmologic, facial, head, neck, spine, thoracic, upper extremity, abdominal, and lower extremity injuries (1–18). Airway compromise stemming from air bag deployment has been reported secondary to thyroid cartilage fracture and blunt trauma (8).
The advent and incorporation of the air bag into motor vehicles has resulted in the mitigation of many head and truncal injuries in motor vehicle collisions. However, air bag deployment is not risk free. We present a case of sodium azide-induced laryngospasm after air bag deployment. An unrestrained male driver was in a moderate-speed motor vehicle collision with air bag deployment. Medics found him awake, gasping for air with stridorous respirations and guarding his neck. The patient had no external signs of trauma and was presumed to have tracheal injury. The patient was greeted by the Anesthesiology service, which intubated him using glidescope-assisted laryngoscopy. The patient was admitted for overnight observation and treatment of alkaline ocular injury and laryngospasm. Although air bags represent an important advance in automobile safety, their use is not without risk. Bruising and tracheal rupture secondary to air bag deployment have been reported in out-of-position occupants. Additionally, alkaline by-products from the combustion of sodium azide in air bags have been implicated in ocular injury and facial burns. Laryngospasm after sodium azide exposure presents another diagnostic challenge for providers. Therefore, it is incumbent to maintain vigilance in the physical examination and diagnosis of occult injuries after air bag deployment.
Great Vessel and Cardiac Trauma
2009, Surgical Clinics of North America
Citation Excerpt :
Seatbelts (active restraints) are more effective than air bags (passive restraints) at preventing aortic injury.8 Airbags have been implicated as a cause of BAI in cars travelling less than 10 mph in some cases.9–11 Overall, it does appear that the use of seatbelts, airbags, and chest protectors has decreased the number of fatalities, the number of associated injuries, and the size of aortic defects in motor vehicle and cycle crashes.12,13
The effect of changing presentation and management on the outcome of blunt rupture of the thoracic aorta
2006, Journal of Thoracic and Cardiovascular Surgery
The management of traumatic aortic rupture has evolved from emergency surgery for all to incorporating nonoperative and endovascular approaches. In addition, the greater emphasis on restraint systems over the past decade might result in lower immediate mortality.
We reviewed our contemporary experience with reference to a previous report from the same institution to determine whether there has been improvement in outcome related to these factors.
In 1990, a review of 104 patients admitted to our center over a 15-year period (1975-1990) noted an overall mortality of 65%. Forty-two patients died before they could reach the operating room, including 15 who were declared dead on arrival and 27 who died before reaching the operating room. All patients underwent angiography, followed by immediate operation. The mortality rate of those who reached the operating room was 34%, and paralysis-paraplegia occurred in 26% of survivors. A review of 53 patients admitted between January 1, 2000, and April 2005 documented an overall mortality of 26% and a paralysis rate of 4.5% in operative survivors. Only 3 patients died during initial evaluation, 2 who were in arrest on arrival. Eight patients were managed nonoperatively, and 13 were managed by means of deliberate delay before intervention to improve physiologic status. Finally, 19 patients were managed with endografts.
The improved outcome over the decade since the initial experience reflects both a reduced severity of injury attributable to restraint systems and a more flexible approach to the acute management, which can modify the effect of associated injuries.
Air bag injuries - A literature review in consideration of demands in forensic autopsies
2002, Forensic Science International
Air bags have been implicated in saving lives and reducing morbidity associated with motor vehicle crashes since their introduction in the mid-1970s. However, there is increasing evidence showing that air bags can be a source of injury and even death in certain circumstances. As the number of air bag-equipped vehicles increases, air bag-related injuries have occurred more frequently. Thus, a greater awareness of air bag-related injuries is required in forensic autopsies. Here, we review thoroughly the literature concerning air bag-related injuries with special regard to their nature and causative mechanisms, and summarize air bag-related injuries observed in adults, children and infants.
Inferior thyroid artery injury due to airbag deployment
2002, Injury

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Case reportOccult ascending aortic rupture in the presence of an air bag

J Emerg Med

Am J Emerg Med

Case report
Occult ascending aortic rupture in the presence of an air bag