Haemopericardium in stable patients after penetrating injury: is subxiphoid pericardial window and drainage enough? A

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Published on: October 24, 2020

Pradeep H Navsaria1, Andrew J Nicol

  • 1Department of Surgery, Trauma Unit C14, Groote Schuur Hospital, Observatory, Anzio Road, Cape Town 7925, South Africa. navasaria@uctgsh1@uct.ac.za

Injury
|May 25, 2005
PubMed

Insights

Stable patients with haemopericardium can often be safely managed with subxiphoid pericardial window (SPW) and drainage, avoiding unnecessary sternotomy. This approach shows promising results for cardiac injury management.

Area of Science:

  • Cardiovascular Surgery
  • Trauma Surgery
  • Emergency Medicine

Background:

  • Haemopericardium in stable patients presents a management dilemma.
  • The role of subxiphoid pericardial window (SPW) and drainage versus sternotomy requires evaluation.

Purpose of the Study:

  • To assess the safety and efficacy of managing stable haemopericardium patients with SPW and drainage only.
  • To determine if sternotomy is always necessary for stable haemopericardium.

Main Methods:

  • Prospective study evaluating stable haemopericardium patients.
  • Diagnosis via SPW; injury grading using AAST criteria after sternotomy for selected cases.
  • Comparison of outcomes for SPW and drainage versus sternotomy.

Main Results:

  • 10 out of 14 (71.4%) stable patients had Grade I-III cardiac injuries, suitable for SPW and drainage.
  • Seven patients managed solely with SPW and drainage showed no complications and were well at follow-up.
  • Four patients with Grade IV injuries had no active bleeding at sternotomy; one death occurred in the acute tamponade group.

Conclusions:

  • SPW and drainage alone is a safe and effective option for a majority of stable haemopericardium patients.
  • Many sternotomies for stable haemopericardium may be non-therapeutic and avoidable.
  • Further randomized trials are needed to confirm these findings and optimize cardiac trauma management.
Abstract

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