title: Emergency department thoracotomy for penetrating injuries of the heart and great vessels: an appraisal of 283 consecutive cases from two urban trauma centers.
abstract: BACKGROUND
  Historically, patients with penetrating cardiac injuries have enjoyed the best survival after emergency department thoracotomy (EDT), but further examination of these series reveals a preponderance of cardiac stab wound (SW) survivors with only sporadic cardiac gunshot wound (GSW) survivors. Our primary study objective was to determine which patients requiring EDT for penetrating cardiac or great vessel (CGV) injury are salvageable.
  
  
  METHODS
  All patients who underwent EDT for penetrating CGV injuries in two urban, level I trauma centers during 2000 to 2007 were retrospectively reviewed. Demographics, injury (mechanism, anatomic injury), prehospital care, and physiology (signs of life [SOL], vital signs, and cardiac rhythm) were analyzed with respect to hospital survival.
  
  
  RESULTS
  The study population (n = 283) comprised young (mean age, 27.1 years +/- 10.1 years) men (96.1%) injured by gunshot (GSW, 88.3%) or SWs (11.7%). Patients were compared by injury mechanism and number of CGV wounds with respect to survival (SW, 24.2%; GSW, 2.8%; p < 0.001; single, 9.5%; multiple, 1.4%; p = 0.003). Three predictors-injury mechanism, ED SOL, and number of CGV wounds-were then analyzed alone and in combination with respect to hospital survival. Only one patient (0.8%) with multiple CGV GSW survived EDT.
  
  
  CONCLUSIONS
  When the cumulative impact of penetrating injury mechanism, ED SOL, and number of CGV wounds was analyzed together, we established that those sustaining multiple CGV GSWs (regardless of ED SOL) were nearly unsalvageable. These results indicate that when multiple CGV GSWs are encountered after EDT, further resuscitative efforts may be terminated without limiting the opportunity for survival.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Temple University School of Medicine, Philadelphia, PA 19104, USA. mark.seamon@tuhs.temple.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Seamon
authors.forename: Adam M
authors.initials: AM
authors.lastname: Shiroff
authors.forename: Michael
authors.initials: M
authors.lastname: Franco
authors.forename: S Peter
authors.initials: SP
authors.lastname: Stawicki
authors.forename: Ezequiel J
authors.initials: EJ
authors.lastname: Molina
authors.forename: John P
authors.initials: JP
authors.lastname: Gaughan
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Reilly
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
authors.forename: John P
authors.initials: JP
authors.lastname: Pryor
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D003331:Coronary Vessels / Q000293:injuries*; D004636:Emergency Service, Hospital; D005260:Female; D006335:Heart Injuries / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D013908:Thoracotomy; D014193:Trauma Centers; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery*; D014951:Wounds, Stab / Q000601:surgery*