Penetrating cardiac injuries and the evolving management algorithm in the current era

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Cardiovascular Surgery

Background:

• Penetrating cardiac injuries are associated with high mortality.
• Diagnostic challenges can delay essential operative intervention.
• Timely diagnosis and treatment are critical for patient survival.

Purpose of the Study:

• To evaluate the impact of diagnostic adjuncts on outcomes for penetrating cardiac injuries.
• To compare the effectiveness of focused assessment with sonography for trauma (FAST) and subxiphoid pericardial window.
• To analyze survival rates and complication profiles before and after the introduction of new diagnostic tools.

Main Methods:

• Retrospective review of 134 consecutive penetrating cardiac injury cases over six years.
• Initial five years relied on clinical diagnosis; final year incorporated focused assessment with sonography for trauma (FAST) and subxiphoid pericardial window.
• Comparison of outcomes between the pre-adjunct and post-adjunct periods.

Main Results:

• Focused assessment with sonography for trauma (FAST) demonstrated a sensitivity of 20% in diagnosing cardiac injuries.
• Subxiphoid pericardial window had a 100% sensitivity and was performed in cases of diagnostic uncertainty or suspected tamponade.
• Survival rates were similar in the pre-adjunct (83%) and post-adjunct (88%) periods, with no significant difference in complications or hospital stay.

Conclusions:

• A high index of suspicion and prompt surgical intervention remain paramount for managing penetrating cardiac injuries.
• Subxiphoid pericardial window is a highly sensitive diagnostic and therapeutic tool for cardiac tamponade in trauma.
• While FAST had limited utility, the introduction of subxiphoid pericardial window did not significantly alter overall survival rates in this series.