Emergency department pericardial drainage for penetrating cardiac wounds is a viable option for stabilization.
BACKGROUND
Penetrating cardiac injuries (PCI) causing tamponade causes subendocardial ischemia, arrhythmias, and cardiac arrest. Pericardial drainage is an important principle, but where drainage should be performed is debated. We hypothesize that drainage in the emergency department (ED) does not delay definitive repair.


METHODS
Over a 16-year period, patients sustaining PCI were reviewed.


RESULTS
Seventy-eight patients with PCI survived to the operating room (OR), with 39 undergoing ED thoracotomy. An additional 39 patients underwent pericardial drainage, 17 (44%) in the ED and 22 in the OR. Comparing the ED with OR pericardial drainage groups, they had a similar ED systolic pressure (99 ± 25 vs 99 ± 34), heart rate (103 ± 16 vs 85 ± 37), median time to the OR (20 vs 22 min), and mortality (12% vs 23%).


CONCLUSIONS
ED pericardial drainage for PCI did not appear to delay operation and had an acceptably low mortality rate. Pericardial drainage is a viable option for stabilization before definitive surgery when surgical intervention is not immediately available in the hemodynamically marginal patient.
Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
Teresa S
TS
Jones
Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA. Electronic address: clay.cothren@dhha.org.
Clay Cothren
CC
Burlew
Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
Robert T
RT
Stovall
Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
Fredric M
FM
Pieracci
Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
Jeffrey L
JL
Johnson
Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
Gregory J
GJ
Jurkovich
Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
Ernest E
EE
Moore
D000328:Adult; D004322:Drainage / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006335:Heart Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D015996:Survival Rate; D013908:Thoracotomy; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*
Cardiac injury; ED thoracotomy; Penetrating trauma; Pericardial drain; Pericardial tamponade; Trauma