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Systematic Review of Penetrating Cardiac Injury by a Firearm: Forensic Implications
Francesco Sessa1, Giuseppe Cocimano2, Massimiliano Esposito1
1Department of Medical, Surgical and Advanced Technologies "G.F. Ingrassia", University of Catania, 95121 Catania, Italy.
Insights
Penetrating cardiac injuries (PCI) from firearms are life-threatening, causing shock and tamponade. Prompt intervention and understanding injury factors are crucial for survival and forensic evaluation.
Area of Science:
- Trauma Surgery
- Cardiovascular Surgery
- Forensic Medicine
Background:
- Penetrating cardiac injuries (PCI) pose immediate risks, including hemorrhagic shock and cardiac tamponade.
- Firearm-related injuries are a significant cause of PCI, demanding urgent medical attention.
Purpose of the Study:
- To systematically review key aspects of penetrating cardiac injuries resulting from firearm wounds.
- To identify factors influencing prognosis and mortality in PCI patients.
Main Methods:
- Systematic review of 39 cases of penetrating cardiac injuries from firearm wounds.
- Analysis of injury location, complications, and patient demographics.
Main Results:
- Most entrance wounds were on the anterior chest (30/39).
- Key complications include myocardial infarction and projectile migration.
- Mortality is influenced by injury severity, intervention time, and associated organ damage.
Conclusions:
- Timely intervention is critical for improving outcomes in penetrating cardiac injuries.
- Understanding prognostic factors is vital for both clinical management and forensic assessment.
- Management strategies for PCI require careful consideration for medical-legal implications.
Abstract:
Penetrating injuries of the heart, named penetrating cardiac injury (PCI), may cause hemorrhagic shock as well as cardiac tamponade, leading to death if not treated immediately. This systematic review aims to highlight the main aspects of penetrating cardiac injuries after firearm wounds. The cases of 39 subjects (age 37.05 + 15.4) were selected (6 fatal cases). Specifically, 4/39 cases involved subjects under 18 y.o.; analyzing the entrance wound, in 30/39 cases it was located in the anterior chest, 4/39 in the posterior chest, 3/39 in the shoulder/axilla area, 1/39 in the neck, and 1/39 in the pelvis (gluteus). The exit wound was found in only 3/39 cases. Several factors may influence the prognosis: firstly, prompt intervention represents a crucial point, then considering the complications related to PCI, the most important are myocardial infarction, and projectile migration with embolization. The mortality rate is related to: (1) area and severity of the heart injury; (2) duration of transport and intervention; (3) contemporary lesion to other organ/s; (4) the quantity of blood lost; (5) and presence/absence of cardiac tamponade. Based on these findings, a correct approach in the management of PCI may be considered important from a forensic point of view, both as regards to medical liability and from the trial perspective.
