Penetrating cardiac injury: Overcoming the limits set by Nature

Kang, Nicholas; Hsee, Li; Rizoli, Sandro; Alison, Peter

doi:10.1016/j.injury.2008.12.008

Cited by 99 publications

(168 citation statements)

References 41 publications

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“…Such a high percentage of survivors might mean that a significant number of injured persons did not reach the hospital in time. Similar observations are also presented by other authors [4,16,24]. In fact, the number of casualties with fatal outcome prior to admission is not known to us; however, some authors suggest that only 6-20% of victims reach hospital alive.…”

Section: Discussionsupporting

confidence: 88%

“…Most patients (151/186, 81.2%) had wounds in the so-called "heart area" (precordium), which is shown in Figure 1. A similar dangerous area is shown by other authors [4,22,23].…”

Section: Cardiac Surgerysupporting

confidence: 87%

“…Patients with stab wounds predominate among persons admitted to hospitals in Europe, South Africa and Brazil [1, 3, 14-17, 24, 25, 29]. However, studies from the USA have shown more gunshot injuries [4,27]. According to Campbell et al [16] gunshot injuries of the heart were found in 33.6% of cases (407/1198).…”

Section: Discussionmentioning

confidence: 99%

“…The most ancient data about cardiac injuries were found as early as in the Edwin Smith papyrus written by the Egyptian Imhotep more than 5000 years ago [1]. Numerous attempts were made to treat patients with heart injuries in ancient times but none of them were successful [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…The majority of patients are young persons. Numerous publications on the subject of injuries to the heart have been published; however, despite huge advances in medicine, only 6-30% of patients reach hospital alive [4,14,15]. Also, most often they reach the hospital in deep hemodynamic shock [4,16,17].…”

Section: Introductionmentioning

confidence: 99%

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CARDIAC SURGERY Penetrating cardiac injuries: 28-year data analysis

Jagelavičius¹,

Budra²,

Jovaišas³

et al. 2013

kitp

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1 StreszczenieWstęp: Rany kłute serca są dramatycznymi, prowadzącymi do zgonu urazami. Na ogół zdarzają się u ludzi młodych. Więk-szość ofiar umiera przed przyjęciem do szpitala. Cel pracy: Celem pracy było określenie czynników decydują-cych o wynikach leczenia i rokowaniu chorych z ranami kłu-tymi serca. , p = 0,031), wyższy stopień urazu (IV-VI) (90,5% vs 29,7%, p < 0,001), uraz prawego przedsionka (28,6% vs 8,5%, p = 0,014) lub lewej komory (42,9% vs 23,0%, p = 0,049) i epizody zatrzymania krążenia (85,7% vs 7,9%, p < 0,001). Niezależnym prognostycznym czynnikiem przeżycia była obecność wszystkich czynników SOL oraz młodszy wiek. Wyższy stopień urazu (IV-VI) oraz zatrzymanie krążenia w trakcie operacji były niezależnymi czynnikami zgonu. Wnioski: Prekursorami złego rokowania były niższe wartości ciśnienia tętniczego oraz brak co najmniej jednego z czynni- CARDIAC SURGERY AbstractBackground: 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%). Associated injuries were evaluated in 57.0% (106/186) of patients. The survival rate on discharge was 88.7%. Compared to non-survivors, the lucky patients had a higher systolic blood pressure on admission (94 mm Hg (IQR: 70-120) versus (vs.) 70 mm Hg (IQR: 0-80), p < 0.001). Survivors had all signs of life (SOL) more often (82.4% vs. 42.9%, p < 0.001), whereas more frequent findings in non-survivors were the following: tamponade (52.4% vs. 29.1%, p = 0.031), higher grade (IV-VI) of injury (90.5% vs. 29.7%, p < 0.001), injured right atrium (28.6% vs. 8.5% p = 0.014) or left ventricle (42.9% vs. 23.0%, p = 0.049) and an episode of heart arrest (85.7% vs. 7.9%, p < 0.001). Independent prognostic factors of survival were the presence of all SOL and younger age. Higher grade (IV-VI) of heart injury and heart arrest during surgery independently predicted mortality. Conclusions: According to our data, lower arterial blood pressure and absence of one or more SOL on admission, cardiac tamponade, higher grade injury, injured right atrium and asystole during operation are true precursors of fatal outcome.

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Section: Discussionsupporting

confidence: 88%

“…Most patients (151/186, 81.2%) had wounds in the so-called "heart area" (precordium), which is shown in Figure 1. A similar dangerous area is shown by other authors [4,22,23].…”

Section: Cardiac Surgerysupporting

confidence: 87%