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Penetrating intrapericardial wounds: clinical experience with a surgical protocol
S B Johnson1, J L Nielsen, E Y Sako
1Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio 78284-7841, USA.
The Annals of Thoracic Surgery
|July 1, 1995
Summary
A standardized treatment protocol for penetrating intrapericardial wounds, involving subxiphoid pericardial window and limited cardiopulmonary bypass, proved effective in a study of 79 trauma patients. This approach resulted in a low overall mortality rate of 6%.
Area of Science:
- Cardiothoracic Surgery
- Trauma Surgery
- Emergency Medicine
Background:
- A treatment protocol for penetrating intrapericardial wounds was developed between 1972-1977.
- The protocol emphasizes immediate OR transport, subxiphoid pericardial window, and limited cardiopulmonary bypass.
Purpose of the Study:
- To evaluate the effectiveness of a standardized treatment protocol for penetrating intrapericardial injuries.
- To assess outcomes in patients undergoing operative repair for acute penetrating intrapericardial trauma.
Main Methods:
- Retrospective review of 79 consecutive patients with acute penetrating intrapericardial injury from March 1978 to July 1991.
- Analysis of injury types (stab vs. gunshot wounds) and wound locations (ventricles, atria, great vessels).
- Evaluation of surgical techniques, including subxiphoid pericardial window and cardiopulmonary bypass utilization.
Main Results:
- The majority of injuries were stab wounds (75%).
- Subxiphoid pericardial window was performed in 67% of patients under local or light general anesthesia.
- Cardiopulmonary bypass was infrequently required (4 patients), and overall mortality was 6%.
Conclusions:
- A systematic approach to trauma victims is crucial.
- The established treatment protocol for penetrating intrapericardial wounds is effective in managing these critical injuries.
