Penetrating cardiac trauma: analysis of 240 cases from a hospital in Bogota, Colombia

Abstract

BackgroundTrauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management.MethodsThis is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed.ResultsThe study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120).ConclusionsThe study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach.

Results of Rendering Medical Aid to Victims With Penetrating Heart Injuries at the General Surgery Department

“…The overwhelming majority of the victims had an open wound that was located in the projection of the dangerous zone of the heart (the Grekov zone, the death box [9]), and 8 (38.1%) patients had two or more wounds (the maximum number of wounds is 16). Two patients were diagnosed atypical location of wounds: in the first case -it was the wound in the left supraclavicular area, in the second -above the left scapula.…”

“…When analyzing the anatomical location of the heart injury, our results do not differ from the literature data [11,12] -most often LV was damaged -in 10 (47.6%) cases. Although, some other authors have pointed out that rV injures are the most common ones [7,9].…”

“…Temporary stopping of bleeding can also be achieved by using a skin stapler, the staples of which can be removed during the final stop of bleeding in the operating room after stabilization of the patient's general condition. however, in the opinion of the researchers, the staples may help to increase the wound and create difficulties in their removal [7], therefore, the suturing of a wound remains the main method of surgery [7,9].…”

“…in the opinion of the majority of authors, the following stages of the operation are distinguished in case of a penetrating injury of the heart: anterolateral thoracotomy at the level of iV-V intercostal space, pericardiotomy, evacuation of blood and clots, temporary hemostasis by plugging the wound with a finger, Foley catheter or Satinsky clamp, sanation of the pericardial cavity with the blood reinfusion, suturing of the pericardium with the "pericardial window" leaving, drainage of the pleural cavity and stitching of the thoracotomic wound [9,11].…”

“…in the literature, this tactic is called "scoop and run". That is, the fastest transportation of the victim to the hospital without attempts to stabilize his condition at the place where the injury occured [7,9,14,15]. Some authors believe that closed cardiopulmonary resuscitation at the prehospital stage in such a contingent of the injured is not only ineffective, but also contraindicated [7].…”