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Arch Hellen Med, 19(3), May-June 2002, 301-304


Penetrating cardiac wounds
Evolution of diagnosis, treatment, and results over a 30 year period

Department of Surgery, Division of Cardiothoracic Surgery, Emory University,
School of Medicine and Grady Memorial Hospital, Atlanta, Georgia, USA

OBJECTIVE Over the years, the causes, the diagnosis and the management of penetrating cardiac wounds have evolved. The objective of this study was to determine the impact of these changes upon the outcome of our patients, treated during the last 30 years.

METHOD From January 1966 to December 1995, we have treated 294 patien ts, 102 during the first decade, 113 during the second decade and 79 during the last decade. The 113 patients treated during the second decade were stratified according to their blood pressure on their ad mission to the emergency service, into four groups. Group I, 29 patients with no blood pressure, group II, 70 patients with systolic arterial pressure ranging from 30 to 90 mmHg, group III, 8 normotensive patients and group IV, 6 patients whose systemic blood pressure was not recorded.

RESULTS The mode of the cardiac injury and the clinical man ifestations were similar between the three decades. However, the initial resuscitation was significantly different. Periocardiocentesis was performed in only 3% of the patients treated during the last decade, whereas in the previous two decades it was performed in 40% and 30% respectively. Emergency room thoracotomy increased from 17% and 20% during the first and second decades respectively to 35% during the last decade. The survival rates were similar during all three decades, 79% in the first, 73% in the second and 78% in the last decade. The overall mortality of all patients treated during the second decade was 27.4%. However, the mortality of the patients who arrested before thoracotomy was 88%, whereas, for those who did not arrest perioperatively, the mortality was 10.2%. The mortality of patients with bullet wounds, 36.1%, was higher than that of those with stab wounds, 23.4%.

CONCLUSIONS This retrospective study indicates that a gunshot wound, unobtainable blood pressure and especially the occurrence of a preoperative or perioperative cardiac arrest are strong predictors for high in hospital mortality of penetrating wounds of the heart. It also shows that the various changes in the diagnosis and management of these injuries have introduced during the last 30 years had minimal impact on the outcome of the patients.

Key words: Cardiac wound, Cardiac tamponade, Penetrating wound.

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