title: Sternotomy or drainage for a hemopericardium after penetrating trauma: a randomized controlled trial.
abstract: OBJECTIVE
  To determine if stable patients with a hemopericardium detected after penetrating chest trauma can be safely managed with pericardial drainage alone.
  
  
  BACKGROUND
  The current international practice is to perform a sternotomy and cardiac repair if a hemopericardium is detected after penetrating chest trauma. The experience in Cape Town, South Africa, on performing a mandatory sternotomy in hemodynamically stable patients was that a sternotomy was unnecessary and the cardiac injury, if present, had sealed.
  
  
  METHODS
  A single-center parallel-group randomized controlled study was completed. All hemodynamically stable patients with a hemopericardium confirmed at subxiphoid pericardial window (SPW), and no active bleeding, were randomized. The primary outcome measure was survival to discharge from hospital. Secondary outcomes were complications and postoperative hospital stay.
  
  
  RESULTS
  Fifty-five patients were randomized to sternotomy and 56 to pericardial drainage and wash-out only. Fifty-one of the 55 patients (93%) randomized to sternotomy had either no cardiac injury or a tangential injury. There were only 4 patients with penetrating wounds to the endocardium and all had sealed. There was 1 death postoperatively among the 111 patients (0.9%) and this was in the sternotomy group. The mean intensive care unit (ICU) stay for a sternotomy was 2.04 days (range, 0-25 days) compared with 0.25 days (range, 0-2) for the drainage (P < 0.001). The estimated mean difference highlighted a stay of 1.8 days shorter in the ICU for the drainage group (95% CI: 0.8-2.7). Total hospital stay was significantly shorter in the SPW group (P < 0.001; 95% CI: 1.4-3.3).
  
  
  CONCLUSIONS
  SPW and drainage is effective and safe in the stable patient with a hemopericardium after penetrating chest trauma, with no increase in mortality and a shorter ICU and hospital stay. (ClinicalTrials.gov Identifier: NCT00823160).
authors.affiliation: *Trauma Center, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; and †Department of Surgery, University of Calgary, Calgary, Canada.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Nicol
authors.forename: Pradeep H
authors.initials: PH
authors.lastname: Navsaria
authors.forename: Martijn
authors.initials: M
authors.lastname: Hommes
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.forename: Sorin
authors.initials: S
authors.lastname: Edu
authors.forename: Delawir
authors.initials: D
authors.lastname: Kahn
mesh_terms: D000328:Adult; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D010491:Pericardial Window Techniques; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D056346:Sternotomy / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013898:Thoracic Injuries / Q000601:surgery*; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000601:surgery*