Thoracic Trauma with Suspected Cardiac Injury on Admission: How Often Is a Cardiothoracic Surgeon Required

Abstract

Introduction: Cardiac involvement in the setting of thoracic trauma is possible with both blunt and penetrating mechanisms. Overall, structural cardiac injury is rare, but when it occurs, it requires immediate diagnosis. We evaluated our process in decision-taking and further surgical procedures if necessary. The aim of this retrospective study is (1) the analysis of cardiac injury patterns and their therapeutic approaches, (2) in how many of these cases a cardiothoracic surgeon is needed in trauma room care and (3) in how many patients cardiothoracic surgery was indicated. Patients and Methods: We analyzed all blunt and penetrating trauma patients with suspected cardiac injury at the time of admission between 7/2016 and 7/2021. Sonography, cardiac enzymes, and electrocardiography were obtained obligatorily. Computed tomography (CT) was carried out in hemodynamically stable patients. Trauma room protocols were analyzed including available Injury Severy Scores (ISS). Data on cardiac injuries, operations, access routes, outcomes and hospitalization were evaluated. Results: In total, 43 patients with cardiac injury at the time of admission could be identified. Contusio cordis was detected in 27 patients (63%), in whom conservative therapy was performed. We indicated surgical intervention in 16 patients (37.2%): nine patients (21%) after blunt chest trauma with cardiac or pericardial injuries, mean ISS 37.3 (9.7). These included tricuspid regurgitation after traumatic rupture of chordae tendineae and rupture of the left atrial appendage. Seven patients (16%) underwent surgery for penetrating chest trauma: six for cardiac knife injury, one patient for iatrogenic drainage dislocation in the left ventricle. Mortality was 22% in surgically treated blunt trauma patients, whereas no mortality was observed in penetrating trauma. Discussion: The most common cardiac injury after blunt thoracic trauma is contusio cordis. In these patients’ surgical treatment is usually not necessary. In contrast, thoracic trauma with structural cardiac injury needs a coordinated and interdisciplinary management in a center with cardiothoracic surgery. In addition to anamnesis and clinical examination, sonography with echocardiography and CT in particular play a decisive role in a rapid diagnosis. In the patients presented in this study, more than every third case required cardiothoracic surgery (16 out of 43 patients, 37.2%). Thus, cardiothoracic expertise should be present for all trauma room patients with suspected cardiac injury.