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Ann Thorac Surg 1992;53:1006-1009
© 1992 The Society of Thoracic Surgeons

Articles

Penetrating cardiac trauma: Management strategy based on 129 surgical emergencies over 2 years

Christopher J. Knott-Craig, MMed(Thor)*, Robert P. Dalton, MD, Gawie J. Rossouw, FCS(SA), Pieter M. Barnard, MD

Departments of Cardiothoracic Surgery, University of Stellenbosch and Tygerberg Hospital, Parow Valley, South Africa

Accepted for publication October 25, 1991.

* Address reprint requests to Dr Knott-Craig, Department of Cardiothoracíc Surgery, The University of Oklahoma, PO Box 26901, Oklahoma City, OK 73190 USA.

Between 1986 and 1988, 129 patients with stab wounds to the heart were referred from the emergency room of our institution for a thoracic surgical procedure. Multiple entrance wounds of the heart were present in 12 patients, and through-and-through stab wounds were encountered in another 10. The overall hospital mortality rate was 8.5% ([equation]), which includes a 54% mortality rate for the 13 patients undergoing emergency room thoracotomy. These patients were pulseless and unconscious either on arrival (n = 8) or soon thereafter (n = 5). Cardiopulmonary bypass was not used during the primary operation, although 7 patients underwent subsequent intracardiac repair with bypass without hospital mortality. Important aspects of our preoperative management strategy include: (1) aggressive transfusion to improve the central venous pressure/intrapericardial pressure gradient; (2) rapid drainage of the pleural and pericardial spaces to reduce intrapericardial pressure; (3) empirical partial correction of metabolic acidosis with sodium bicarbonate; and (4) emergency operation without unnecessary cardiac imaging. Patients suspected of having penetrating cardiac trauma and cardiac tamponade are best managed by aggressive primary intervention and immediate operation.




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