This was a retrospective study undertaken at our trauma unit over a period of 7 years, between February 2005 and March 2012. All patients with penetrating cardiac injuries resulting from stab wounds were included in this study. Penetrating cardiac injury was defined as any injury affecting the pericardium and its content and this injury was confirmed intraoperatively for all patients. We identified patients by diagnosis from the hospital’s trauma registry. The medical records of patients who underwent operation for penetrating cardiac injury were reviewed. The following epidemiologic and trauma related data were carried out: name, age, sex, mechanism of injury, clinical findings on admission, diagnosis, surgical treatment and complications. All study patients had manifested signs of life in the field and/or during transport.
According to the clinical status on admission, we distinguished patients with unrecordable vital signs (unconscious with no detectable pulse and blood pressure), patients with signs of low cardiac output in whom systolic blood pressure (SBP) remains < 90 mmhg and hemodynamically stable patients with SBP > 90 mmhg. The management strategy for all patients presenting in the emergency room with precordial wounds, especially with hypotension and distended neck veins, included immediate central venous access (usually through subclavian vein) rapid crystalloid infusion and insertion of a chest tube on the side of the injury. If the patients remained lifeless and the transferring paramedic didn’t report any recordable signs of life during transport, the patients were intubated and transferred to the operating room with ongoing cardiopulmonary resuscitation (CPR).
For patients who lost their vital signs in the resuscitation room, they underwent emergency department thoracotomy (EDT). Patients with systolic blood pressure less than 90 mmhg were directly transferred to the operating theatre for surgical exploration. Stabilized patients with suspected cardiac injury underwent chest x-ray and transthoracic echocardiography (TTE), any visible fluid or clot in the pericardial space was considered to be positive. Subxyphoid window (SPW) with pericardial decompression has been reserved for stable patients with delayed presentation of traumatic pericardial effusion and for those who undergone a laparotomy with suspiscion of cardiac trauma.
Patients were usually explored via median sternotomy, left anterior thoracotomy was performed for EDT. Injuries of the cardiac chamber were repaired with Teflon mattress suture. Distal coronaries arteries lesions were repaired by simple ligation. Cardiopulmonary bypass wasn’t used in this acute setting. Ethical approval was not required because the study was done retrospectively and all patients were managed according to available guidelines at that moment. A new protocol or medication was not evaluated.
All continuous variables are expressed as mean with standard deviation. The categorical data were expressed as frequency and percentage. Chi square test was applied for comparing categorical variables. The Student Test was used for the comparison of continuous variables. A multiple logistic regression analysis was performed to estimate independent predictive factors for death. This model included risk factors that were first identified by univariate analysis. A p < 0.05 was statistically significant. Data processing and analysis were performed using SPSS for windows, version 13 (SPSS, Inc, Chicago, IL, USA).