Traumatic pericardial effusion: impact of diagnostic and surgical approaches.
BACKGROUND
In trauma patients with chest injuries, traumatic pericardial effusion is an important scenario to consider because of its close linkage to cardiac injury. Even with advances in imaging, diagnosis remains a challenge and use of which surgical approach is controversial. This study reviews the treatment algorithm, surgical outcomes, and predictors of mortality for traumatic pericardial effusion.


METHODS
Information on demographics, mechanisms of trauma, injury scores, diagnostic tools, surgical procedures, associated injuries, and hospital events were collected retrospectively from a tertiary trauma center.


RESULTS
Between June 2003 and December 2009, 31 patients (23 males and 8 females) with a median age of 31 (range 16-77), who had undergone surgical drainage of pericardial effusion were enrolled in the study. Blunt trauma accounted for 27 (87.1%) insults, and penetrating injury accounted for 4 (12.9%). Patients were diagnosed by Focused Assessment with Sonography for Trauma (FAST) (8 patients), computerized tomography (7 patients), echocardiography (9 patients), and incidentally during surgery (7 patients). Notably, sixteen (51.7%) patients required surgical repair for traumatic cardiac ruptures, including 6 (19.6%) with pericardial defects who presented initially with hemothorax. The surgical approaches were subxiphoid in 8 patients (25.8%), thoracotomy in 7 (22.6%), and sternotomy in 19 (61.2%), including 3 conversions from thoracotomy. The survival to discharge rate was 77.4% (24/31). Concomitant cardiac repair, associated pericardial defects, and initial surgical approach did not affect survival, but the need for massive transfusion, cardiopulmonary cerebral resuscitation (CPCR), trauma score, and incidental discovery at surgery all had a significant impact on the outcome.


CONCLUSIONS
Precise diagnoses of traumatic pericardial effusions are still challenging and easily omitted even with FAST, repeat cardiac echo and CT. The number of patients with traumatic pericardial effusion requiring surgical repair is high. Standardized therapeutic protocol, different surgical approaches have not impact on survival. Correct identification, prompt drainage, and preparedness for concomitant cardiac repair seem to be the key to better outcomes.
Huang
Yao-Kuang
YK
Division of Thoracic and Cardiovascular Surgery and Heart Failure Center, Chang Gung Memorial Hospital, Linkou Center, Chang Gung University, College of Medicine, Taiwan, ROC. huang137@mac.com
Lu
Ming-Shian
MS
Liu
Kuo-Sheng
KS
Liu
Erh-Hao
EH
Chu
Jaw-Ji
JJ
Tsai
Feng-Chun
FC
Lin
Pyng Jing
PJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006335:Heart Injuries / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D013898:Thoracic Injuries / Q000150:complications*; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications; D014950:Wounds, Penetrating / Q000150:complications