Outcomes after emergency department thoracotomy for penetrating cardiac injuries: a new perspective

• Published in: Interactive cardiovascular and thoracic surgery Vol. 7; no. 5; pp. 845 - 848
• Main Authors: Molina, Ezequiel J, P. Gaughan, John, Kulp, Heather, B. McClurken, James, J. Goldberg, Amy, J. Seamon, Mark
• Format: Journal Article
• Language: English
• Published: England Eur Assoc Cardio Surg 01.10.2008; European Association for Cardio-Thoracic Surgery
• Subjects: Adolescent; Adult; Emergency Service, Hospital - statistics & numerical data; Female; Heart Injuries - mortality; Heart Injuries - surgery; Humans; Logistic Models; Male; Medical Futility; Patient Selection; Philadelphia - epidemiology; Retrospective Studies; Risk Assessment; Thoracotomy - mortality; Treatment Outcome; Urban Health Services - statistics & numerical data; Wounds, Penetrating - mortality; Wounds, Penetrating - surgery; Philadelphia; Emergency; Thoracotomy; Trauma; Penetrating; Surgery
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2008.183293

a Department of Surgery, Temple University Hospital, Suite 400, Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA b Department of Physiology and Biostatistics, Temple University Hospital, 3401 N Broad St., Philadelphia, PA 19140, USA *Corresponding author. Tel.: +1 215 707 4545. E-mail address : ejmolina{at}gmail.com (E.J. Molina). Previous reports have described penetrating cardiac injuries as the anatomic injury with the greatest opportunity for emergency department thoracotomy (EDT) survival. We hypothesize that actual survival rates are lower than that initially reported. A retrospective review of our EDT experience was performed. Data collected included injury mechanism and location, presence of measurable ED vital signs, initial ED cardiac rhythm, GCS, method of transportation, and survival. Logistic regression analysis identified predictors of survival. Ninety-four of 237 patients presented penetrating cardiac injuries after EDT. Eighty-nine patients (95%) were males. Measurable ED vital signs were present in 15 patients (16%). Cardiac injuries were caused by GSW in 82 patients (87%) and SW in 12 patients (13%). Fifteen patients (16%) survived EDT and were taken to the operating room, while eight patients (8%) survived their entire hospitalization. All survivors were neurologically intact. Survival rates were 5% for GSW and 33% for SW. Mechanism of injury (SW), prehospital transportation by police, higher GCS, sinus tachycardia, and measurable ED vital signs were associated with improved survival. In urban trauma centers where firearm injuries are much more common than stabbings, the presence of a penetrating cardiac injury may no longer be considered a predictor of survival after EDT. Key Words: Trauma; Penetrating; Surgery; Emergency; Thoracotomy Related Article eComment: Emergency department thoracotomy and middle income countries Narcis Hudorovic Interactive CardioVascular and Thoracic Surgery 2008 7: 848-849. [Full Text] [PDF]