Abstract
BackgroundThe purpose of this study was to identify factors associated with unfavourable outcome following stab wounds to the heart in order to improve selection of patients who may benefit from resuscitative effort.MethodsFrom February to March, variables were collected from medical records of patients sustaining cardiac trauma. The inclusion criterion was the presence of a penetrating cardiac injury confirmed intraoperatively.ResultsNinety-eight patients were admitted with penetrating cardiac injury. The mortality rate was 60 %. Fifty-seven patients had unrecordable blood pressure at admission and emergency department thoracotomy was done in twelve patients. The AAST-OIS score was higher in non survivors group (4,21 vs 4,49). Multivariate analysis identified tamponade, associated injuries, right ventricular laceration as the most predictive variables for mortality.DiscussionStab wounds should be separated from gunshots wounds as the former mechanism has different pathophysiological issue. Patients arriving without signs of life may benefit from aggressive resuscitative efforts depending on transport time.ConclusionPenetrating cardiac injuries are highly lethal condition. Cardiac tamponade, right ventricle lacerations and associated extra-cardiac injuries are independent risk factors of death.
Highlights
The purpose of this study was to identify factors associated with unfavourable outcome following stab wounds to the heart in order to improve selection of patients who may benefit from resuscitative effort
Patients were usually explored via median sternotomy, left anterior thoracotomy was performed for emergency department thoracotomy (EDT)
Median sternotomy was used in 86 patients and left anterior thoracotomy was performed for EDT and in some stable patients
Summary
The purpose of this study was to identify factors associated with unfavourable outcome following stab wounds to the heart in order to improve selection of patients who may benefit from resuscitative effort. Stab wounds of the heart represent a significant surgical challenge because of their unpredictable clinical course and the need for emergency clinical care often including emergency room thoracotomy. The diagnostic workup of patients with suspected cardiac injury was predominantly clinical. In the current era, a number of new diagnostic and therapeutic modalities have been introduced in clinically stable patients. Reported outcomes in the literature are widely variable, reflecting a variety of presentation, injury mechanism, prehospital care capabilities and geographic situation. Series are heterogeneous comprising stab and gunshot wounds, these concerns prompted us to review our institutional experience in an attempt to describe and compare the variables associated with patients
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