ECMO-/ECLS

aortic contour abnormalities, peri-aortic hematoma, focal aortic dissection,
endoluminal thrombus, or active contrast extravasation may also be seen. In
cases where results are equivocal, catheter-directed angiography may be
necessary.
Aortic injuries require urgent operative repair. Since these patients often
have other associated injuries, prioritization in management is essential. Life-
threatening issues involving airway, breathing, and circulation are addressed
first. In the face of intra-abdominal hemorrhage and hemodynamic instability,
laparotomy should be performed before any other procedure, including
aortography or aortic repair. Stable patients are otherwise admitted to the
intensive care unit for further resuscitation and strict heart rate and blood
pressure control until definitive care is appropriate. Short acting b-blockers,
such as esmolol, are preferred to reduce shear stress on the aortic wall and risk
of free rupture.
In the pediatric population, open repair for aortic injury is the standard
management. The operative procedure of choice for traumatic aortic injury
repair is the “clamp and sew” technique. This procedure is performed by
occluding the proximal aorta and repairing the aorta without establishing a
bypass for distal perfusion. This procedure avoids the need for distal vascular
cannulation and, more importantly, anti-coagulation, which would increase the
risk of bleeding in a multiply injured patient. Although this procedure is the
simplest and fastest technique for aortic repair, it has a higher risk of paraplegia
and renal failure.