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Published on: March 17, 2020
Penetrating cardiac injuries
V Mittal1, P McAleese, S Young
1Department of Surgery, Grace Hospital, Detroit, Michigan, USA.
Insights
Penetrating cardiac injuries from stabbings have a higher survival rate (80%) than gunshot wounds (47%). Prompt resuscitation and surgical management are key for survival in these critical heart injuries.
Area of Science:
- Trauma Surgery
- Cardiovascular Surgery
- Emergency Medicine
Background:
- Penetrating cardiac injuries are life-threatening emergencies.
- Understanding factors influencing survival is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the impact of clinical factors on survival rates in patients with penetrating heart injuries.
- To evaluate the effectiveness of different interventions, including emergency room (ER) and operating room (OR) thoracotomy.
Main Methods:
- Retrospective review of 80 consecutive cases of penetrating cardiac injuries treated between 1980 and 1994.
- Analysis of patient demographics, injury types (gunshot vs. stab wounds), associated injuries, hemodynamic status on admission, and intervention type.
- Comparison of survival rates based on these clinical factors and interventions.
Main Results:
- Overall survival rate was 65% (52/80 patients).
- Stab wounds had a significantly higher survival rate (80%) compared to gunshot wounds (47%).
- Emergency room thoracotomy was associated with lower survival (22%) compared to operating room interventions, particularly in non-survivors (86% of ER thoracotomies were performed on non-survivors).
Conclusions:
- A selective approach to emergency room thoracotomy is recommended for penetrating cardiac injuries.
- Prompt resuscitation and immediate definitive surgical management are critical for improving survival rates in these severe injuries.
Abstract:
Our objective was to determine the influence of several clinical factors on the survival of patients with penetrating wounds to the heart. A retrospective review of 80 consecutive penetrating cardiac injuries treated in a Level II urban trauma center from 1980 through 1994 were examined. Thirty-six patients (45%) had gunshot wounds (including 1 shotgun wound), and 44 (55%) had stab wounds. Intervention consisted of emergency room (ER) or operating room thoracotomy. We measured the effect of several clinical factors on morbidity and patient survival. Survival rate was 17 of 36 (47%) in gunshot injuries and 35 of 44 (80%) in stab injuries, with an overall survival rate of 52 of 80 patients (65%). The average age was 24 years (range, 9-53), and there were 3 female patients. Twelve patients (15%) had multiple cardiac injuries, and 63 (79%) had other associated injuries. Fourteen patients (17%) presented with no blood pressure, and 55 (69%) were hypotensive on admission. ER thoracotomy was performed on 7 of 52 survivors (13%) and 24 of 28 nonsurvivors (86%). Survival after ER thoracotomy was 7 of 31 patients (22%). A selective approach is recommended, because ER thoracotomy has a limited role in penetrating cardiac injury. A high index of suspicion, prompt resuscitation, and immediate definitive surgical management resulted in a high survival rate for these frequently lethal injuries.
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