title: Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center.
abstract: BACKGROUND
  Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical.
  
  
  METHODS
  From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center.
  
  
  RESULTS
  Over the 10-year study, 80 PCI patients survived to reach the hospital. Of the 21 factors analyzed, prehospital cardiopulmonary resuscitation (odds ratio [OR] = 30), scene time greater than 10 minutes (OR = 58), resuscitative thoracotomy (OR = 19), and massive left hemothorax (OR = 15) had the greatest impact on mortality. Cardiac tamponade physiology demonstrated a "protective" effect for survivors to the hospital (OR = .08).
  
  
  CONCLUSIONS
  Trauma surgeons can improve mortality after PCI by minimizing time to the operating room for early control of hemorrhage. In PCI patients, tamponade may provide a physiologic advantage (lower mortality) compared to exsanguination.
authors.affiliation: Department of Surgery, Emory University School Medicine, Grady Memorial Hospital, Atlanta, GA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mina
authors.affiliation: Department of Surgery, Emory University School Medicine, Grady Memorial Hospital, Atlanta, GA, USA.
authors.forename: Rashi
authors.initials: R
authors.lastname: Jhunjhunwala
authors.affiliation: Department of Surgery, Emory University School Medicine, Grady Memorial Hospital, Atlanta, GA, USA.
authors.forename: Rondi B
authors.initials: RB
authors.lastname: Gelbard
authors.affiliation: Department of Surgery, Emory University School Medicine, Grady Memorial Hospital, Atlanta, GA, USA.
authors.forename: Stacy D
authors.initials: SD
authors.lastname: Dougherty
authors.affiliation: Department of Surgery, Emory University School Medicine, Grady Memorial Hospital, Atlanta, GA, USA.
authors.forename: Jacquelyn S
authors.initials: JS
authors.lastname: Carr
authors.affiliation: Department of Surgery, Emory University School Medicine, Grady Memorial Hospital, Atlanta, GA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dente
authors.affiliation: Department of Surgery, Gwinnett Medical Center, Lawrenceville, GA, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Nicholas
authors.affiliation: Department of Surgery, Atlanta Medical Center, Atlanta, GA, USA.
authors.forename: Amy D
authors.initials: AD
authors.lastname: Wyrzykowski
authors.affiliation: Department of Surgery, Banner Desert Medical Center, Mesa, AZ, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Salomone
authors.affiliation: Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Vercruysse
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: David V
authors.initials: DV
authors.lastname: Feliciano
authors.affiliation: Department of Surgery, Emory University School Medicine, Grady Memorial Hospital, Atlanta, GA, USA. Electronic address: bcmorse@emory.edu.
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Morse
mesh_terms: D000328:Adult; D005260:Female; D006335:Heart Injuries / Q000150:complications / Q000401:mortality* / Q000628:therapy; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D012151:Resuscitation; D012189:Retrospective Studies; D015996:Survival Rate; D061665:Time-to-Treatment; D014193:Trauma Centers; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000150:complications / Q000401:mortality* / Q000628:therapy; D055815:Young Adult
keywords: Cardiac box; Cardiac injury; ED thoracotomy; Penetrating cardiac injury; Penetrating cardiac wound; Tamponade