Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center

Abstract Background Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. Methods From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with...

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Bibliographic Details
Published in:The American journal of surgery 2017-06, Vol.213 (6), p.1109-1115
Main Authors: Mina, Michael J., M.D., Ph.D, Jhunjhunwala, Rashi, B.A, Gelbard, Rondi B., M.D, Dougherty, Stacy D., M.D, Carr, Jacquelyn S., M.D, Dente, Christopher J., M.D., F.A.C.S, Nicholas, Jeffrey M., M.D., F.A.C.S, Wyrzykowski, Amy D., M.D., F.A.C.S, Salomone, Jeffrey P., M.D., F.A.C.S, Vercruysse, Gary A., M.D., F.A.C.S, Feliciano, David V., M.D., F.A.C.S, Morse, Bryan C., M.S., M.D., F.A.C.S
Format: Article
Language:English
Subjects:
Abdomen
Adult
Cardiac box
Cardiac injury
Confidence intervals
ED thoracotomy
Emergency medical care
Female
Heart
Heart diseases
Heart Injuries - complications
Heart Injuries - mortality
Heart Injuries - therapy
Hemorrhage
Hemothorax
Hospitals
Hospitals, Urban
Humans
Injuries
Injury analysis
Lethality
Male
Medical personnel
Middle Aged
Mortality
Ostomy
Patients
Penetrating cardiac injury
Penetrating cardiac wound
Physiology
Resuscitation
Retrospective Studies
Stabbings
Surgeons
Surgery
Survival Rate
Tamponade
Time-to-Treatment
Trauma
Trauma Centers
Treatment Outcome
Wounds, Penetrating - complications
Wounds, Penetrating - mortality
Wounds, Penetrating - therapy
Young Adult
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Summary:Abstract Background Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. Methods From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center. Results Over the 10-year study, 80 PCI patients survived to reach the hospital. Of the 21 factors analyzed, prehospital cardiopulmonary resuscitation (odds ratio [OR] = 30), scene time greater than 10 minutes (OR = 58), resuscitative thoracotomy (OR = 19), and massive left hemothorax (OR = 15) had the greatest impact on mortality. Cardiac tamponade physiology demonstrated a “protective” effect for survivors to the hospital (OR = .08). Conclusions Trauma surgeons can improve mortality after PCI by minimizing time to the operating room for early control of hemorrhage. In PCI patients, tamponade may provide a physiologic advantage (lower mortality) compared to exsanguination.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2016.07.014