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Does hemopericardium after chest trauma mandate sternotomy?

Chad M Thorson1, Nicholas Namias, Robert M Van Haren

  • 1Division of Trauma and Surgical Critical Care, Dewitt-Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center/Jackson Memorial Hospital, Miami, Florida 33136, USA.

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Trauma-induced hemopericardium does not always require sternotomy. Some stable patients with chest trauma and hemopericardium can be managed nonoperatively, avoiding unnecessary sternotomies.

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Area of Science:

  • Trauma Surgery
  • Cardiothoracic Surgery
  • Emergency Medicine

Background:

  • Chest trauma can lead to hemopericardium, a condition where blood accumulates in the pericardial sac.
  • The necessity of sternotomy for trauma-induced hemopericardium has been debated.
  • Previous nonoperative management of hemopericardium after severe chest trauma prompted further investigation.

Purpose of the Study:

  • To evaluate the hypothesis that trauma-induced hemopericardium mandates sternotomy.
  • To determine the appropriate management for patients with chest trauma and hemopericardium.
  • To identify predictors of therapeutic sternotomy in trauma patients.

Main Methods:

  • Retrospective review of patients with chest trauma and pericardial window or median sternotomy at a Level I trauma center (December 1996 to November 2011).
  • Analysis of patient demographics, injury mechanisms, hemodynamic status, diagnostic procedures (focused cardiac ultrasound), and surgical interventions.
  • Statistical analysis, including multiple logistic regression, to identify predictors of therapeutic sternotomy.

Main Results:

  • Of 377 patients with positive pericardial window, 55 (15%) proceeded to sternotomy, predominantly due to penetrating trauma (89%).
  • Hypotension on arrival or during resuscitation was observed in 35% of patients.
  • Ventricular injuries were common, but 38% of patients undergoing sternotomy had no repairable cardiac or great vessel injury, indicating nontherapeutic sternotomies.

Conclusions:

  • Hemopericardium alone may be an oversensitive indicator for cardiac or great vessel injury after chest trauma.
  • Selected stable patients with blunt or penetrating trauma and hemopericardium without ongoing bleeding may avoid nontherapeutic sternotomies.
  • Nonoperative management should be considered for selected trauma patients with hemopericardium to prevent unnecessary surgical intervention.