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Penetrating cardiac injuries
S Attar1, C M Suter, J R Hankins
1Department of Surgery, University of Maryland School of Medicine and Hospital, Baltimore.
Insights
Penetrating cardiac injuries from gunshots have a worse prognosis than stab wounds. Aggressive treatment, including emergency room thoracotomy, is crucial for survival in critical patients with heart injuries.
Area of Science:
- Trauma Surgery
- Cardiovascular Surgery
- Emergency Medicine
Background:
- Penetrating cardiac injuries are a significant cause of mortality.
- Prompt and appropriate management is critical for patient survival.
Purpose of the Study:
- To analyze survival rates and outcomes for patients with penetrating cardiac injuries.
- To compare the prognosis of gunshot wounds versus stab wounds to the heart.
- To evaluate the effectiveness of different surgical interventions.
Main Methods:
- Retrospective review of 109 patients with penetrating cardiac injuries.
- Classification of patients into four groups based on hemodynamic stability (lifeless, agonal, shock, stable).
- Analysis of thoracotomy timing (emergency room vs. operating room) and injury type (gunshot vs. stab).
Main Results:
- Overall survival was 61% (67/109).
- Patients undergoing operating room thoracotomy had higher survival rates (87%) compared to emergency room thoracotomy (38%).
- Gunshot wounds had a significantly worse prognosis (40% survival) than stab wounds (78% survival).
- Survival rates increased with hemodynamic stability: Group 1 (31%), Group 2 (69%), Group 3 (79%), Group 4 (82%).
Conclusions:
- Gunshot wounds to the heart carry a poorer prognosis than stab wounds.
- Aggressive treatment, including timely thoracotomy, is warranted for patients with penetrating cardiac injuries, even those who are hemodynamically unstable.
- The timing and location of thoracotomy significantly impact survival outcomes.
Abstract:
One hundred nine penetrating cardiac injuries were reviewed: 49 gunshot wounds and 60 stab wounds. They were classified into four groups: group 1 (lifeless), 38; group 2 (agonal), 16; group 3 (shock), 33; and group 4 (stable), 22. Thirty-six patients in group 1 (94%) and 8 of 16 patients in group 2 (50%) underwent emergency room thoracotomy; 24 of 33 in group 3 (73%) and 20 of 22 (90%) underwent thoracotomy in the operating room. Twenty-one (38%) of 55 patients undergoing emergency room thoracotomy survived, whereas 47 (87%) of 54 patients undergoing operating room thoracotomy survived. Survival was 12 of 38 (31%) in group 1, 11 of 16 (69%) in group 2, 26 of 33 (79%) in group 3, and 18 of 22 (82%) in group 4 with an overall survival of 67 of 109 (61%). Gunshot wounds of the heart portend a worse prognosis than stab wounds. Survival of gunshot wounds was 20 of 49 (40%) compared with 47 survivors of 60 stab wounds (78%). Aggressive treatment, including emergency room thoracotomy, is justified for lifeless and deteriorating cardiac injury victims.