Increasing numbers of penetrating cardiac trauma in a new center

JPMA. The Journal of the Pakistan Medical Association, 2018

Penetrating cardiac trauma is a medical emergency that commonly affects young men throughout the world. A retrospective review of the records of all patients presenting with cardiac injury was done from January 2000 to December 2015 at our institute. There were 10 cases of such trauma, all of whom were males, 17 to 48 years of age. The most common mechanism of injury was gunshot wounds followed by stab wounds. The Mean Revised Trauma Score was 7.23±0.855. Only 2 out of the total 10 patients died (20% mortality). The Right Ventricle followed by the Left Ventricle was the most common site of injury. Median Sternotomy was the surgical procedure of choice in managing these patients. Pericardial tamponade and Haemothorax were common intra-operative findings. Patients having penetrating cardiac injury presenting with detectable signs of life on arrival to the hospital can be rescued by early surgical intervention.

Kosuyolu Heart Journal, 2018

Introduction: Penetrating traumas, including gunshot and stab wounds, are the major causes of cardiac trauma. The aim of this study was to evaluate the diagnosis and surgical treatment in penetrating cardiac trauma patients. Patients and Methods: Forty-eight patients who underwent surgery for penetrating cardiac trauma between February 2009 and May 2017 were reviewed retrospectively. Transthoracic echocardiography, computed tomography angiography, and laboratory studies were performed if the patient was hemodynamically stable. Results: A total of 48 patients (45 males, 3 females; mean age 29.4 ± 11.1 years, range 16-51 years) were operated. Etiology was stab wound injury in 46 (95.8%) patients. Twenty-nine (60.4%) patients were in cardiogenic shock. In 44 cases, median sternotomy was performed. The most affected cardiac chamber was the right ventricle in 28 (58.3%) patients. The most common accompanying organ injury was the lungs with 15 patients. The mortality rate was 27.1% with 13 patients. Hemodynamic status of the patient, requirement of preoperative CPR, and preoperative hematocrit levels were found to have a significant effect on mortality. Conclusion: In penetrating cardiac trauma, early diagnosis and emergency surgery will improve overall survival rates. The hemodynamic status of patients on arrival have significant effect on prognosis.

Indian Journal of Thoracic and Cardiovascular Surgery, 2009

2013

Background: Penetrating cardiac injuries are a dramatic and lethal form of trauma. They are usually sustained by young people. The majority of victims die before reaching the hospital. Aim of the study: The aim of the study was to establish prognostic criteria for the outcome of penetrating cardiac injury. Material and methods: We retrospectively reviewed the records of 186 patients with penetrating cardiac injuries who were operated on during the first 24 hours after admission. Results: The mean age was 33 (interquartile range (IQR): 26-44) years. 88.7% of victims were male. The mean time from the moment of trauma to arrival at the hospital in Vilnius city was 60 minutes (IQR: 50-91), whereas from the Vilnius region it was 240 (IQR: 82-390) minutes. The vast majority of patients (176/186, 94.6%) sustained stab wounds. Hemopericardium or cardiac tamponade (142/186, 76.3%) usually was found at the operation. Right ventricle was the most often injured heart chamber (75/186, 40.3%). As...

Turkish Journal of Trauma and Emergency Surgery, 2011

Penetran kalp yaralanmaları nadirdir ancak yüksek mortalite gösterir. Yaralanmalarda erken tanı ve hızlı müdahale gereklidir. Penetran kalp yaralanması ile görülen hastaların karakteristikleri ve bir eğitim hastanesinde acil hizmeti veren genel cerrahların bireysel tecrübeleri dahil bu hastalarda sağkalımı etkileyen faktörler irdelendi.

Trauma and Emergency Care

Introduction: In Mexico, despite having experience in cardiac trauma (TRACAR), there are few reports. We present the surgical experience of two Trauma Hospitals in Mexico City. Methods: A retrospective analysis of patients with TRACAR treated in Hospital "Balbuena" and "La Villa" was performed between the period from 01 January 2012 to 31 December 2017. Results: 23 patients were included in this study. 13 (56.5%) survivors and 10 (43.5%) non survivors. The ratio male/female was 12/1 vs 9/1, regarding the type of lesion (firearm projectiles, [FP] vs penetrating object, [PO]) and survival, [FP 7 (53.85%) vs PO 6 (46.15%)] vs [FP 8 (80%) vs PO 2 (20%)]. The frequency of wounds was the following: pericardium 9 (28.11%) vs 6 (18.75%), right ventricle 5 (15.63%) vs 6 (18.75%), left ventricle 1 (13.13%) vs 2 (6.25%), right atrium 2 (6.25%) vs 1 (3.13%). Regarding the AAST classification of the frequency was; grade I:6 (46.15%) vs 2(20%), grade II: 4 (30.76%) vs 0, grade III: 3 (23.09%) vs 4 (40%). The utilized surgical approach was left anterolateral : 14 (8[61.54%] vs. 6[60%]); bilateral: 4 (2[15.39%] vs. 2[20%]); sternotomy 3 (1[7.69%] vs. 2[20%]); combined 1 (1 [7.69%] vs. 0); and right 1: (1(7.69%) vs 0). Conclusion: Cardiac trauma is an entity with a high mortality which requires urgent treatment; it currently occurs in younger populations predominantly by firearm projectiles. Our results are consistent with those reported on other series.

2005

To present our experience with penetrating cardiac injuries. We have retrospectively reviewed the records of 70 victims of penetrating cardiac injuries. A logistic regression has been performed in order to determine the association between death and clinical predictors. Penetrating injuries consisted of 43 stab wounds (61.4%) and 27 (38.6%) gunshot injuries (Ps0.72). There were 63 (90%) male and 7 female (10%, P-0.001) victims. The mean age was 27.36"11.51, ranging from 3 to 65 years. The overall mortality was 32.9%, 47.8% for gunshot wounds and 52.2% for stab wounds (Ps0.266). Eight victims (11.4%) had associated intra-thoracic great vessel injuries and 17 (24.3%) presented associated intra-abdominal organ injuries. The incidence of injured chamber was: right ventricle 37.1%, right atrium 27.1%, left ventricle 25.7%, and left atrium 5.7%. Non-survivors had lower systolic blood pressure (37.50"39.18 mmHg) than survivors (79.04"41.04 mmHg; P-0.001) upon arrival at the hospital. Thirteen non-survival (56.5%) and 10 (21.3%) survival victims had systolic blood pressure (SBP) F50 mmHg (Ps0.001). The level of systolic blood pressure (SBPF50 mmHg) and consciousness upon arrival at the hospital are predictors of outcome in victims of penetrating cardiac injuries.

The Annals of Thoracic Surgery, 1992

Between 1986 and 1988,129 patients with stab wounds to the heart were referred from the emergency room of our institution for a thoracic surgical procedure. Multiple entrance wounds of the heart were present in 12 patients, and through-and-through stab wounds were encountered in another 10. The overall hospital mortality rate was 8.5% (11/129), which includes a 54% mortality rate for the 13 patients undergoing emergency room thoracotomy. These patients were pulseless and unconscious either on arrival (n = 8) or soon thereafter (n = 5). Cardiopulmo-

The purpose of this investigation was to evaluate factors affecting the outcome following penetrating cardiac trauma in a developing country and to compare our results with others in developed countries. Analysis of the cause of trauma, age, sex, different tools of investigations used, concomitant organ injuries, SBP, GCS, ISS, RTS, TRISS and mortality were performed. This study included 35 patients; all were males. Mortality rate was 22.8%. It was significant with low SBP (p =0.021), GCS ˂ 9 (p =0.02), non-presentation with tamponade (p = 0.023), low ISS (p =0.02), low RTS (p =0.007), low TRISS (p = 0.003), less blood transfusion (p =0.001) and longer time before entrance to OR (p= 0.019). Meanwhile, mortality were not significant with age (p =0.33), mechanism of injury (p =0.16), other associated injuries (p =0.16) or associated intra-abdominal injuries (p= 0.16). Rapid assessment and prompt surgical intervention may reduce mortality. Even in a developing country, mortality rates could reach those in developed countries depending on clinical skills and accessible technology tools.

The purpose of this investigation was to evaluate factors affecting the outcome following penetrating cardiac trauma in a developing country and to compare our results with others in developed countries. Analysis of the cause of trauma, age, sex, different tools of investigations used, concomitant organ injuries, SBP, GCS, ISS, RTS, TRISS and mortality were performed. This study included 35 patients; all were males. Mortality rate was 22.8%. It was significant with low SBP (p =0.021), GCS ˂ 9 (p =0.02), non-presentation with tamponade (p = 0.023), low ISS (p =0.02), low RTS (p =0.007), low TRISS (p = 0.003), less blood transfusion (p =0.001) and longer time before entrance to OR (p= 0.019). Meanwhile, mortality were not significant with age (p =0.33), mechanism of injury (p =0.16), other associated injuries (p =0.16) or associated intra-abdominal injuries (p= 0.16). Rapid assessment and prompt surgical intervention may reduce mortality. Even in a developing country, mortality rates could reach those in developed countries depending on clinical skills and accessible technology tools.