Hemorrhage Control in Penetrating Cardiac Injury: A New Device Put to the Test in the Advanced Trauma Operative Management (ATOM) Course

Abstract

Penetrating cardiac injuries cause death through exsanguination, cardiac tamponade, and fulminant cardiac failure. 1 Ballistic trauma and stab wounds are the most common mechanisms involved in penetrating wounds to the heart. Studies of unselected series of patients with penetrating cardiac injuries show a death on the arrival rate of 80-90%; 18% were considered salvageable cases if the right treatments were available. 2,3 Consequently, expeditious management of these injuries and immediate hemorrhage control are critical to improve the survival rate. The ideal way to control the hemorrhage is to digitally occlude the injury followed by suture. However, a procedure like this is difficult to perform in the emergency department. Additionally, the lack of physician experience in the treatment of these injuries increases the rate of poor outcome. The first heart suture was successfully attempted in 1882 by Block in a rabbit model. 4 The first attempt in a human was in 1896 by Cappelen. 5 He had to repair a left ventricular laceration and ligate the coronary artery; the patient died in the postoperative period. Rehn of Frankfurt is credited with the first successful repair of a penetrating cardiac injury in 1896, operating on a wound in the right ventricle. 6 Several reports followed that successful repair. Dr Rehn published additional 124 events with 60% successful outcomes. 7 During World War II, Dr Harken from the