A Graded Approach to the Management of Penetrating Wounds of the Heart

Steichen, Felicien M.; Dargan, Everett L.; Efron, Gershon; Pearlman, Donald M.; Weil, Peter H.

doi:10.1001/archsurg.1971.01350110072011

Cited by 50 publications

(5 citation statements)

References 21 publications

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“…Most patients with penetrating cardiac wounds do not reach the hospital alive (2,4,10,16,18). According to American literature the transport mortality there is between 60 and 81 %.…”

Section: Discussionmentioning

confidence: 99%

“…The work of Blalock and Ravitch (6), who advocated emergency pericardiocentesis, has considerably influenced the approach of generations of surgeons since 1943. In the more recent literature (1,2,3,5,7,8,11,15,16,17,18,19,20) there is a clear tendency away from the more conservative plan of management to early and more aggressive surgical intervention. Even today, "a penetrating wound of the pericardium and the heart is one of the most dramatic and potentially demanding emergencies that a "surgeon has to manage" (2).…”

mentioning

confidence: 99%

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Penetrating Wounds of the Heart and Pericardium

Radtke¹,

Lubbe²,

Jansön³

et al. 1979

Thorac cardiovasc Surg

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Fifty-seven patients with penetrating cardiac or pericardial trauma were treated at the Department of Cardio-Thoracic Surgery, University of Stellenbosch at the Tygerberg Hospital during a 6 1/2 year period from June 1971 to January 1978. Eleven patients were treated by aspiration alone because tamponade was mild, or because they were seen between 24 hours and 3 weeks after injury. Six patients underwent late elective surgery. Cardiopulmonary bypass had to be employed in four patients to correct intracardiac lesions. All other patients underwent emergency operations 8 minutes to 2 hours after admission to hospital. The hospital mortality was 4 of 57 patients (7%), lower than rates reported in other series. Some selected cases will be described more fully and our present plan of management is outlined.

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“…Most patients with penetrating cardiac wounds do not reach the hospital alive (2,4,10,16,18). According to American literature the transport mortality there is between 60 and 81 %.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Penetrating Wounds of the Heart and Pericardium

Radtke¹,

Lubbe²,

Jansön³

et al. 1979

Thorac cardiovasc Surg

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“…Their ages ranged from 12 to 53 years with a mean of 26 years. These patients were divided into three clinical groups as suggested by Steichen et al (1971). Group A consisted of 18 'lifeless' patients who were received without blood pressure, pulse or respiration and the pupils were usually fixed and dilated.…”

Section: Methodsmentioning

confidence: 99%

“…Mattox et al (1974) reported 100 per cent mortality in 1 1 such 'lifeless' patients out of 48 who were treated for penetrating cardiac injuries. Other reported mortality rates have varied from 50 to 67 per cent (Steichen et al, 1971;Symbas et al, 1976) ( Table V ) .…”

Section: Martin Luther King Jr Generalmentioning

confidence: 97%

Experience in the management of 50 consecutive penetrating wounds of the heart

Mandal

Awariefe

Oparah

1979

Journal of British Surgery

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Fifty patients with penetrating wounds of the heart were grouped into three categories, based on the clinical severity of the injuries. Gunshot wounds consistently resulted in a higher mortality than knife wounds. Central venous pressure (CVP) was the single most important means of determining cardiac tamponade. The survival rates in the respective groups were 6, 79 and 100 per cent. The improved survival in our series was due to a rapid transportation system, increased awareness of the significance of cardiac injuries and an aggressive surgical approach.

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“…Penetrating cardiac injuries have been generally classified into three categories based upon their initial clinical presentation (Table 1). First described over 20 years ago, this is a simple classification system which requires no additional assessment beyond that normally accomplished within the trauma bay (28). In one study of 64 patients classified with this system, overall survival was 23% for Group I, 79% for Group II, and 100% for Group III (29).…”

Section: Prognosismentioning

confidence: 99%