Penetrating cardiac injuries

Morse, Bryan C.; Mina, Michael J.; Carr, Jacquelyn S.; Jhunjhunwala, Rashi; Dente, Christopher J.; Zink, John U.; Nicholas, Jeffrey M.; Wyrzykowski, Amy D.; Salomone, Jeffrey P.; Vercruysse, Gary; Rozycki, Grace S.; Feliciano, David V.

doi:10.1097/ta.0000000000001165

Cited by 49 publications

(55 citation statements)

References 24 publications

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“…We are unable to comment on how proximal saphenous vein cut-down or Seldinger technique(22) might compare to the techniques we observed here as this technique is rarely if ever practiced at our center. As expected in a cohort of patients undergoing resuscitative thoracotomy, there was an extremely high mortality rate which limits our ability to describe longer term outcomes associated with different types of IV access (23).…”

Section: Discussionmentioning

confidence: 98%

The intraosseous have it: A prospective observational study of vascular access success rates in patients in extremis using video review

Chreiman¹,

Dumas

Seamon

et al. 2018

J Trauma Acute Care Surg

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Section: Discussionmentioning

confidence: 98%

The intraosseous have it: A prospective observational study of vascular access success rates in patients in extremis using video review

Chreiman¹,

Dumas

Seamon

et al. 2018

J Trauma Acute Care Surg

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“…With the development of the FAST examination, which can be performed rapidly at the bedside in any patient with penetrating chest injury, the PCW procedure is rarely performed in the current era. 5 17 The current Western Trauma Association (WTA) algorithm for penetrating chest trauma recommends sternotomy for patients with penetrating chest injury with positive cardiac FAST examination. 8 …”

Section: Discussionmentioning

confidence: 99%

“…In this setting, the FAST examination has diminished the role of the PCW to detect the presence of cardiac injuries, and this decline in the PCW has been recognized by other authors. 5 19 However, in the discussion of management of PCIs, the WTA acknowledges the increasing experience of avoiding sternotomy if the window is ‘mildly’ positive. 8 Options discussed include direct cardiac observation, mediastinoscopy or thoracoscopy to inspect the cardiac surface, or application of biologic glues over the surface of the heart in partial thickness injuries.…”

Section: Discussionmentioning

confidence: 99%

Selective use of pericardial window and drainage as sole treatment for hemopericardium from penetrating chest trauma

Chestovich

McNicoll

Fraser

et al. 2018

Trauma Surg Acute Care Open

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BackgroundPenetrating cardiac injuries (PCIs) are highly lethal, and a sternotomy is considered mandatory for suspected PCI. Recent literature suggests pericardial window (PCW) may be sufficient for superficial cardiac injuries to drain hemopericardium and assess for continued bleeding and instability. This study objective is to review patients with PCI managed with sternotomy and PCW and compare outcomes.MethodsAll patients with penetrating chest trauma from 2000 to 2016 requiring PCW or sternotomy were reviewed. Data were collected for patients who had PCW for hemopericardium managed with only pericardial drain, or underwent sternotomy for cardiac injuries grade 1–3 according to the American Association for the Surgery of Trauma (AAST) Cardiac Organ Injury Scale (OIS). The PCW+drain group was compared with the Sternotomy group using Fisher’s exact and Wilcoxon rank-sum test with P<0.05 considered statistically significant.ResultsSternotomy was performed in 57 patients for suspected PCI, including 7 with AAST OIS grade 1–3 injuries (Sternotomy group). Four patients had pericardial injuries, three had partial thickness cardiac injuries, two of which were suture-repaired. Average blood drained was 285 mL (100–500 mL). PCW was performed in 37 patients, and 21 had hemopericardium; 16 patients proceeded to sternotomy and 5 were treated with pericardial drainage (PCW+drain group). All PCW+drain patients had suction evacuation of hemopericardium, pericardial lavage, and verified bleeding cessation, followed by pericardial drain placement and admission to intensive care unit (ICU). Average blood drained was 240 mL (40–600 mL), and pericardial drains were removed on postoperative day 3.6 (2–5). There was no significant difference in demographics, injury mechanism, Revised Trauma Score exploratory laparotomies, hospital or ICU length of stay, or ventilator days. No in-hospital mortality occurred in either group.ConclusionsHemodynamically stable patients with penetrating chest trauma and hemopericardium may be safely managed with PCW, lavage and drainage with documented cessation of bleeding, and postoperative ICU monitoring.Level of evidenceTherapeutic study, level IV.

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“…Estas diferencias en los mecanismos condicionan las tasas de mortalidad. En países desarrollados la tasa de mortalidad de las heridas cardiacas por proyectil de arma de fuego es de 45-90 % y por arma blanca del 19-24 % [12][13][14] , en comparación con nuestra serie, donde se observa una mortalidad del 55 % y el 13,2 % respectivamente para cada tipo de mecanismo.…”

Section: Características Sociodemográficas Y Mecanismos De Lesiónunclassified

“…En publicaciones internacionales, la localización más frecuente de la herida fue en el ventrículo derecho (60 %), al igual que la presente serie. Sin embargo, las tasas de lesión del ventrículo izquierdo y las heridas multicamerales sí presentan una diferencia amplia, siendo menores en nuestra serie: 37 % vs 22 % y 18 % vs 4,3 %, lo que posiblemente es explicado por la menor frecuencia de heridas por proyectil de arma de fuego en el presente estudio 14 .…”

Section: Características Sociodemográficas Y Mecanismos De Lesiónunclassified

De la puerta de urgencias al quirófano: revelando los minutos de oro en trauma cardíaco penetrante

et al. 2021

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Introducción. El manejo de la herida cardiaca penetrante es un reto dado que requiere un rápido manejo quirúrgico para evitar que su desenlace sea fatal. Múltiples factores pronósticos han sido descritos, sin embargo, no ha sido documentada la relación entre el tiempo de llegada a quirófano y el uso de pledgets con la mortalidad. Métodos. Se realizó un estudio observacional retrospectivo de corte transversal, desde el año 2011 hasta el año 2018, en un hospital universitario de la ciudad de Medellín. Se evaluaron los registros de los pacientes con herida cardiaca penetrante confirmada y se realizó análisis univariado, bivariado y multivariado, así como curvas de supervivencia. Resultados. Los pacientes inestables o con taponamiento cardiaco que llegan al quirófano después del minuto 4 de haber ingresado a urgencias tienen cuatro veces más posibilidades de morir que los que llegan a quirófano antes (RR 4,1 IC95% 1,43–12,07). El uso de pledgets en el reparo de la herida cardiaca, corresponde a un factor protector para los pacientes, con un OR ajustado de 2,5 (IC95% 1,124-5,641). El tipo de traumatismo, la arritmia intraoperatoria y el índice de choque al ingreso también fueron factores pronósticos. Discusión. Se documenta el efecto del tiempo de llegada a quirófano sobre la mortalidad, lo cual permitirá en un futuro generar cambios en el manejo de estos pacientes en función de estos tiempos. La evidencia encontrada sugiere mejores desenlaces con el uso rutinario de pledgets.

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Penetrating cardiac injuries

Abstract: Therapeutic study, level IV; epidemioligc study, level III.

Cited by 49 publications

References 24 publications

The intraosseous have it: A prospective observational study of vascular access success rates in patients in extremis using video review

The intraosseous have it: A prospective observational study of vascular access success rates in patients in extremis using video review

Selective use of pericardial window and drainage as sole treatment for hemopericardium from penetrating chest trauma

De la puerta de urgencias al quirófano: revelando los minutos de oro en trauma cardíaco penetrante

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