title: Analysis of 285 cardiac penetrating injuries in the Lebanon war.
abstract: This study evaluates factors influencing survival in 285 battle cardiac injuries, treated in Lebanon from 1969 to 1982. Survival factors included age (mean 18 years), transportation lag (mean distance 2 miles), wounding agents (shrapnel, gunshot), hospital logistics, and early surgical treatment. The overall survival was 73% (208 patients) compared to 60% from World War II and 67% from recent civilian report. Treatment logistics included a specialized centre with ambulance radio communication. The state of shock at arrival influenced survival: 146 of 188 patients with mild shock survived (78%) with 61% (53 patients) survival in the profound shock group, treated similarly. The site of cardiac injury influenced outcome. Survival was best in the 9 patients with coronary vessel wounds (100%), atrial wounds 80% (56 survivors) but dropped to 46% (17 survivors) in left ventricular injury reflecting pump failure, and 51% (19 survivors) in multiple cardiac wounds. The causes of cardiac mortality and survivor follow-up were evaluated. The study indicates that despite predetermined factors overall survival is significantly improved by early transportation, precise logistics, and urgent surgery.
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006335:Heart Injuries / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D012151:Resuscitation; D012774:Shock, Traumatic / Q000503:physiopathology; D013997:Time Factors; D014187:Transportation of Patients; D014948:Wounds, Gunshot / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*