Penetrating Cardiac Injuries: Recent Experience in South Africa

Degiannis, Elias; Loogna, Peter; Doll, Dietrich; Bonanno, Fabrizio Giuseppe; Bowley, Douglas M.; Smith, Martin D.

doi:10.1007/s00268-005-0463-5

Cited by 141 publications

(110 citation statements)

References 34 publications

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“…In agreement with others, our results have shown that victims of penetrating cardiac injuries are predominantly young males [1,3,14,16,20,24,25,30].…”

Section: Discussionsupporting

confidence: 93%

“…According to Degiannis et al data, 46% of patients with a single stab wound had it in the precordium. The mortality rate among patients with precordium stab wounds was 4%, whereas among persons with non-precordium stab wounds it was 25%, with a statistically significant difference (p = 0.03) [14]. Navsaria et al [15] reported that a stab wound in the precordium resulted in heart injury in 60% of cases (in our study -71.5%); Penetrating cardiac injuries: 28-year data analysis on the other hand, 85% of the heart-injured persons had a wound in the precordium area (in our data -81.2%).…”

Section: Discussionmentioning

confidence: 88%

“…For the rest the operation was delayed due to numerous reasons. In some clinics and hospitals patients with suspected heart injury were being operated on at the emergency department operating room [4,14,20,22,27]. All the patients in our series were operated on in the operating theatre of the Department of General Thoracic Surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of patients are young persons. Numerous publications on the subject of injuries to the heart have been published; however, despite huge advances in medicine, only 6-30% of patients reach hospital alive [4,14,15]. Also, most often they reach the hospital in deep hemodynamic shock [4,16,17].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, most knowledge involving injuries of the heart and aorta comes from American studies or South Africa series, due to increased violence in these societies compared with Western Europe [14]. Since the transition to democracy in South Africa in 1994, there has been a gradual reduction in trauma [14].…”

Section: Introductionmentioning

confidence: 99%

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CARDIAC SURGERY Penetrating cardiac injuries: 28-year data analysis

Jagelavičius¹,

Budra²,

Jovaišas³

et al. 2013

kitp

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1 StreszczenieWstęp: Rany kłute serca są dramatycznymi, prowadzącymi do zgonu urazami. Na ogół zdarzają się u ludzi młodych. Więk-szość ofiar umiera przed przyjęciem do szpitala. Cel pracy: Celem pracy było określenie czynników decydują-cych o wynikach leczenia i rokowaniu chorych z ranami kłu-tymi serca. , p = 0,031), wyższy stopień urazu (IV-VI) (90,5% vs 29,7%, p < 0,001), uraz prawego przedsionka (28,6% vs 8,5%, p = 0,014) lub lewej komory (42,9% vs 23,0%, p = 0,049) i epizody zatrzymania krążenia (85,7% vs 7,9%, p < 0,001). Niezależnym prognostycznym czynnikiem przeżycia była obecność wszystkich czynników SOL oraz młodszy wiek. Wyższy stopień urazu (IV-VI) oraz zatrzymanie krążenia w trakcie operacji były niezależnymi czynnikami zgonu. Wnioski: Prekursorami złego rokowania były niższe wartości ciśnienia tętniczego oraz brak co najmniej jednego z czynni- CARDIAC SURGERY AbstractBackground: Penetrating cardiac injuries are a dramatic and lethal form of trauma. They are usually sustained by young people. The majority of victims die before reaching the hospital. Aim of the study: The aim of the study was to establish prognostic criteria for the outcome of penetrating cardiac injury. Material and methods: We retrospectively reviewed the records of 186 patients with penetrating cardiac injuries who were operated on during the first 24 hours after admission. Results: The mean age was 33 (interquartile range (IQR): 26-44) years. 88.7% of victims were male. The mean time from the moment of trauma to arrival at the hospital in Vilnius city was 60 minutes (IQR: 50-91), whereas from the Vilnius region it was 240 (IQR: 82-390) minutes. The vast majority of patients (176/186, 94.6%) sustained stab wounds. Hemopericardium or cardiac tamponade (142/186, 76.3%) usually was found at the operation. Right ventricle was the most often injured heart chamber (75/186, 40.3%). Associated injuries were evaluated in 57.0% (106/186) of patients. The survival rate on discharge was 88.7%. Compared to non-survivors, the lucky patients had a higher systolic blood pressure on admission (94 mm Hg (IQR: 70-120) versus (vs.) 70 mm Hg (IQR: 0-80), p < 0.001). Survivors had all signs of life (SOL) more often (82.4% vs. 42.9%, p < 0.001), whereas more frequent findings in non-survivors were the following: tamponade (52.4% vs. 29.1%, p = 0.031), higher grade (IV-VI) of injury (90.5% vs. 29.7%, p < 0.001), injured right atrium (28.6% vs. 8.5% p = 0.014) or left ventricle (42.9% vs. 23.0%, p = 0.049) and an episode of heart arrest (85.7% vs. 7.9%, p < 0.001). Independent prognostic factors of survival were the presence of all SOL and younger age. Higher grade (IV-VI) of heart injury and heart arrest during surgery independently predicted mortality. Conclusions: According to our data, lower arterial blood pressure and absence of one or more SOL on admission, cardiac tamponade, higher grade injury, injured right atrium and asystole during operation are true precursors of fatal outcome.

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“…In agreement with others, our results have shown that victims of penetrating cardiac injuries are predominantly young males [1,3,14,16,20,24,25,30].…”

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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CARDIAC SURGERY Penetrating cardiac injuries: 28-year data analysis

Jagelavičius¹,

Budra²,

Jovaišas³

et al. 2013

kitp

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Postdischarge Complications After Penetrating Cardiac Injury

et al. 2011

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Hypothesis: A significant rate of postdischarge complications is associated with penetrating cardiac injuries. Design: Retrospective trauma registry review. Setting: Level I trauma center. Patients: All patients sustaining penetrating cardiac inju-riesbetweenJanuary2000andJune2010.Patientdemographics, clinical data, operative findings, outpatient follow-up, echocardiogram results, and outcomes were extracted. Main Outcome Measures: Cardiac-related complications and mortality. Results: During the 10.5-year study period, 406 of 40 706 trauma admissions (1.0%) sustained penetrating cardiac injury. One hundred nine (26.9%) survived to hospital discharge. The survivors were predominantly male (94.4%), with a mean (SD) age of 30.8 (11.7) years, and 74.3% sustained a stab wound. Signs of life were present on admission in 92.6%. Cardiac chambers involved were the right ventricle (45.9%), left ventricle (40.3%), right atrium (10.1%), left atrium (0.9%), and combined (2.8%). Inhospital follow-up was available for a mean (SD) of 11.0 (9.8) days (median, 8 days; range, 3-65 days) and outpatient follow-up was available in 46 patients (42.2%) for a mean (SD) of 1.9 (4.1) months (median, 0.9 months; range, 0.2-12 months). Abnormal echocardiograms demonstrated pericardial effusions (9), abnormal wall motion (8), decreased ejection fraction (Ͻ45%) (8), intramural thrombus (4), valve injury (4), cardiac enlargement (2), conduction abnormality (2), pseudoaneurysm (1), aneurysm (1), and septal defect (1). No operative intervention was required for the complications. The 1-year and 9-year survival rates were 97% and 88%, respectively. Conclusions: Penetrating cardiac injuries remain highly lethal. A significant rate of cardiac complications can be expected and follow-up echocardiographic evaluation is warranted prior to discharge. The majority of these, however, can be managed without the need for surgical intervention.

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Emergency Management of Cardiac Trauma

Napier

Messent

2010

Cardiovascular Critical Care

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Penetrating Cardiac Injuries: Recent Experience in South Africa

Cited by 141 publications

References 34 publications

CARDIAC SURGERY Penetrating cardiac injuries: 28-year data analysis

CARDIAC SURGERY Penetrating cardiac injuries: 28-year data analysis

Postdischarge Complications After Penetrating Cardiac Injury

Emergency Management of Cardiac Trauma

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