Predictors of survival after penetrating cardiac trauma: injury patterns and presentation factors

Penetrating cardiac trauma is associated with high mortality. Factors influencing survival remain incompletely characterized. This study aimed to identify injury patterns and presentation characteristics associated with survival after penetrating cardiac trauma at an urban, level 1 trauma center.

We conducted a retrospective cohort study of patients with penetrating cardiac trauma identified from the hospital trauma registry between 2017 and 2025. Patients with documented penetrating cardiac injury were included. Demographic, physiological, and injury characteristics were compared between survivors and non-survivors using the Mann-Whitney U test for continuous variables and Pearson's χ² test or Fisher's test for categorical variables. Univariate Firth's logistic regression was used to calculate ORs with 95% CIs.

Among 18 041 trauma activations, 57 patients with penetrating cardiac injury were identified. Overall survival was 25%. Gunshot wound (GSW) was the most common mechanism of injury (67%) and was associated with a higher risk of mortality compared with stab wound injuries (SWIs) (OR 3.70, 95% CI 1.10 to 12.1). Multichamber cardiac injury (OR 10.9, 95% CI 1.26 to 1439), thoracic vascular injury (OR 12.3, 95% CI 1.43 to 1615), and concurrent abdominal injury (OR 4.40, 95% CI 1.12 to 24.7) were associated with death. Conversely, isolated cardiac injury (OR 0.21, 95% CI 0.06 to 0.75), spontaneous respirations (OR 0.06, 95% CI 0.01 to 0.24), and signs of life on presentation (OR 0.01, 95% CI 0 to 0.10) were predicted survival.

Penetrating cardiac trauma carries a high mortality rate. Survival was associated with SWI, preserved physiologic status on presentation, and injuries isolated to the heart, whereas GSW and concurrent thoracic vascular or abdominal injuries were associated with death. Recognition of these factors may assist clinicians in early triage and resuscitative decision-making.Level of evidence: level III, prognostic study.