Penetrating cardiac injuries: twenty-year experience

Area of Science:

• Trauma Surgery
• Cardiovascular Surgery
• Emergency Medicine

Background:

• Penetrating cardiac injuries pose significant mortality risks.
• Historical data on emergency room thoracotomy outcomes is limited.
• Trends in trauma presentation, including gunshot wounds, have evolved.

Purpose of the Study:

• To analyze the survival rates of patients undergoing emergency room thoracotomy for penetrating cardiac injuries.
• To evaluate the impact of delayed thoracotomy on patient mortality.
• To assess the evolving incidence of severe cardiac injuries and patient presentation.

Main Methods:

• Retrospective analysis of 228 patients with penetrating cardiac injuries treated between 1963 and 1983.
• Comparison of survival rates based on initial vital signs and patient condition upon arrival (vital signs vs. in extremis).
• Evaluation of the effect of thoracotomy timing on mortality, particularly in patients with profound shock.

Main Results:

• Patients arriving with vital signs had a 73% survival rate, compared to 29% for those arriving in extremis.
• Delayed thoracotomy was associated with increased mortality in critically ill patients.
• An increasing trend in gunshot wounds and patients presenting in extremis was observed over the study period.

Conclusions:

• Emergency room thoracotomy is a vital intervention for penetrating cardiac injuries.
• Timely surgical intervention significantly impacts survival rates.
• Urban trauma centers require enhanced emergency room capabilities, including operating rooms, to manage cardiac emergencies effectively.