Evaluation of penetrating cardiac stab wounds
Mehdi Bamous1, Abdou Abdessamad2, Jawad Tadili3
1Department of Cardiac Surgery, Mohamed V Military Hospital, Mohamed V University, Rabat, Morocco. mehdibamous@hotmail.com.
Insights
Cardiac stab wounds are highly lethal, with a 60% mortality rate. Key predictors of death include cardiac tamponade, right ventricular lacerations, and associated injuries, guiding resuscitation efforts.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Cardiovascular Surgery
Background:
- Penetrating cardiac injuries pose a significant threat to life.
- Identifying prognostic factors is crucial for optimizing patient selection for resuscitation.
Purpose of the Study:
- To identify factors associated with unfavorable outcomes after stab wounds to the heart.
- To improve the selection of patients who may benefit from resuscitative efforts.
Main Methods:
- Retrospective analysis of medical records for patients with penetrating cardiac injuries.
- Inclusion criterion: intraoperatively confirmed cardiac trauma.
Main Results:
- Ninety-eight patients admitted with penetrating cardiac injury; 60% mortality.
- Unrecordable blood pressure on admission and emergency department thoracotomy were noted in a subset of patients.
- Multivariate analysis revealed cardiac tamponade, associated injuries, and right ventricular laceration as significant predictors of mortality.
Conclusions:
- Stab wounds to the heart have distinct pathophysiology compared to gunshot wounds.
- Cardiac tamponade, right ventricle lacerations, and extra-cardiac injuries are independent risk factors for mortality.
- Patients without signs of life may benefit from aggressive resuscitation, considering transport time.
Background:
The purpose of this study was to identify factors associated with unfavourable outcome following stab wounds to the heart in order to improve selection of patients who may benefit from resuscitative effort.
Methods:
From February to March, variables were collected from medical records of patients sustaining cardiac trauma. The inclusion criterion was the presence of a penetrating cardiac injury confirmed intraoperatively.
Results:
Ninety-eight patients were admitted with penetrating cardiac injury. The mortality rate was 60 %. Fifty-seven patients had unrecordable blood pressure at admission and emergency department thoracotomy was done in twelve patients. The AAST-OIS score was higher in non survivors group (4,21 vs 4,49). Multivariate analysis identified tamponade, associated injuries, right ventricular laceration as the most predictive variables for mortality.
Discussion:
Stab wounds should be separated from gunshots wounds as the former mechanism has different pathophysiological issue. Patients arriving without signs of life may benefit from aggressive resuscitative efforts depending on transport time.
Conclusion:
Penetrating cardiac injuries are highly lethal condition. Cardiac tamponade, right ventricle lacerations and associated extra-cardiac injuries are independent risk factors of death.
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