Cardiac injuries--a clinical and autopsy profile
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P Kulshrestha1, B Das, K S Iyer
1Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi.
Insights
Cardiac injuries are often fatal, with most deaths occurring before hospital arrival. Prompt surgical intervention significantly improves survival rates for the few patients who reach medical facilities.
Area of Science:
- Trauma Surgery
- Cardiovascular Surgery
- Emergency Medicine
Background:
- Cardiac injuries pose a significant threat to life.
- Understanding the natural history of these injuries is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the natural history of cardiac injuries.
- To identify factors influencing survival in patients with cardiac trauma.
Main Methods:
- Retrospective analysis of 102 patients with cardiac injuries over a 4-year period.
- Categorization of injuries by mechanism (blunt, stab, gunshot) and anatomical location (ventricle, atrium, pulmonary artery).
- Evaluation of prehospital and in-hospital mortality rates and survival factors.
Main Results:
- High prehospital mortality: 32.3% died on scene, 56.9% during transport.
- Only 10.8% of patients reached the hospital alive; 10 of these survived after surgical repair.
- Blunt trauma had lower survival rates (2.2%) compared to stab (19.4%) and gunshot injuries (14.3%).
- Ventricular injuries, particularly left ventricular, had higher prehospital mortality.
- Right ventricular injuries showed higher survival rates (11.3%) than left ventricular injuries (3%).
Conclusions:
- Rapid transport, immediate recognition, and aggressive surgical management are critical for improving survival in cardiac injuries.
- Timely thoracotomy and repair offer a chance of survival for patients reaching the hospital.
- Mechanism and location of cardiac injury significantly impact prehospital mortality and survival prognosis.
Abstract:
One hundred two patients sustaining cardiac injuries over a 4-year period were analysed to highlight the natural history of the cardiac injuries. There were 45 blunt, 36 stab, and 21 gunshot injuries. The injury involved the ventricle in 85, atrium in seven, pulmonary artery in five cases, and resulted in crush injury to the heart in the remaining five cases. Thirty-three patients (32.3%) died on the scene and 58 (56.9%) died during the transportation. Only 11 patients (10.8%) reached the hospital alive, and ten of these patients survived following thoracotomy and repair of the cardiac injury. The factors influencing the natural course of cardiac injury were analysed: 2.2% of patients with blunt cardiac trauma reached the hospital alive compared to 19.4% with stab and 14.3% with gunshot injuries; ventricular injuries had a greater prehospital mortality compared to atrial or pulmonary artery injuries; 11.3% of patients sustaining injury to right ventricle reached the hospital alive compared to 3% of those with left ventricular injuries. These data emphasize the need for rapid transport, immediate recognition, and aggressive surgical management, to make a favourable impact on the natural history of cardiac injuries.