Penetrating cardiac trauma: management strategy based on 129 surgical emergencies over 2 years.
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). Cardiopulmonary bypass was not used during the primary operation, although 7 patients underwent subsequent intracardiac repair with bypass without hospital mortality. Important aspects of our preoperative management strategy include: (1) aggressive transfusion to improve the central venous pressure/intrapericardial pressure gradient; (2) rapid drainage of the pleural and pericardial spaces to reduce intrapericardial pressure; (3) empirical partial correction of metabolic acidosis with sodium bicarbonate; and (4) emergency operation without unnecessary cardiac imaging. Patients suspected of having penetrating cardiac trauma and cardiac tamponade are best managed by aggressive primary intervention and immediate operation.
Knott-Craig
C J
CJ
Department of Cardiothoracic Surgery, University of Stellenbosch, Parow Valley, South Africa.
Dalton
R P
RP
Rossouw
G J
GJ
Barnard
P M
PM
D000293:Adolescent; D000328:Adult; D002648:Child; D004630:Emergencies; D005260:Female; D006335:Heart Injuries / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014951:Wounds, Stab / Q000401:mortality / Q000601:surgery*