title: Factors affecting prognosis with penetrating wounds of the heart.
abstract: OBJECTIVE
  To determine factors affecting prognosis for patients with penetrating wounds of the heart.
  
  
  METHODS
  A retrospective review of 302 patients with penetrating heart wounds undergoing emergency thoracotomy (August of 1980 through June of 1997) in a Level I trauma center.
  
  
  RESULTS
  There were 148 patients with gunshot wounds (GSW) and 154 patients with stab wounds with 23% and 58% survival rates, respectively. Of 43 patients having no signs of life at the scene, 5 patients (12%) achieved some cardiac activity and were brought to the operating room (OR), but none survived. Of 67 patients "arresting" in the ambulance, 23 got to the OR, but only 3 patients (4%) survived. Of 27 patients "arresting" in the emergency department (ED), 18 patients reached the OR, but only 5 patients (19%) survived. Of 15 patients having an ED thoracotomy because of rapid deterioration there, 4 patients (27%) survived. Thus, of the 152 patients with an ED thoracotomy, 93 patients had gunshot wounds and none survived; of the 59 with stab wounds, 12 (20%) survived (p < 0.001). Of 150 patients having an OR thoracotomy, 111 (74%) survived. Single-chamber injuries had a survival rate of 51% (112 of 219 patients), but multiple chamber and/or intrapericardial great vessel injuries had only a 13% survival rate (11 of 83 patients) (p < 0.001). Intrapericardial aortic injuries were uniformly fatal in 15 patients. In patients with stab wounds, pericardial tamponade was associated with a higher survival rate (66%; 56 of 84 patients) than in those without tamponade (47%; 33 of 70 patients).
  
  
  CONCLUSIONS
  The physiologic status of the patient at presentation, mechanism of injury, and presence of a tamponade were significant prognostic factors in this series of penetrating cardiac injuries. Multiple-chamber injuries, especially with great vessel involvement, were associated with a high mortality rate. ED thoracotomies for gunshot wounds of the heart were uniformly fatal.
authors.affiliation: Wayne State University School of Medicine and Detroit Receiving Hospital, Michigan 48201, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Tyburski
authors.forename: L
authors.initials: L
authors.lastname: Astra
authors.forename: R F
authors.initials: RF
authors.lastname: Wilson
authors.forename: C
authors.initials: C
authors.lastname: Dente
authors.forename: C
authors.initials: C
authors.lastname: Steffes
mesh_terms: D000328:Adult; D001011:Aorta / Q000293:injuries; D002305:Cardiac Tamponade / Q000150:complications; D004630:Emergencies; D005260:Female; D006335:Heart Injuries / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013908:Thoracotomy; D014948:Wounds, Gunshot / Q000401:mortality / Q000601:surgery; D014950:Wounds, Penetrating / Q000401:mortality* / Q000601:surgery; D014951:Wounds, Stab / Q000401:mortality / Q000601:surgery