PENETRATING CARDIAC WOUNDS - PROSPECTIVE-STUDY OF FACTORS INFLUENCINGINITIAL RESUSCITATION

A prospective study of 66 consecutive patients with cardiac wounds see n over a 27-month period is reported. No patient was excluded. Patient s were stratified by injury mechanism and by physiologic scoring at ad mission using the cardiovascular-respiratory elements of the Trauma Sc ore (CVRS). Admission cardiac rhythm was obtained in patients with a C VRS of 0 and a Glasgow Coma Scale (GCS) score of 3. Information concer ning the anatomic extent of the cardiac wound, the presence or absence of tamponade, and the degree of injury to other structures was also c ollected prospectively. Seventy percent of the cardiac wounds were cau sed by gunshots. The probability of successful resuscitation was signi ficantly related to mechanism of injury and physiologic condition on a rrival. Among patients arriving with a CVRS of 0 and a GCS score of 3, survival correlated with cardiac rhythm. Pericardial tamponade did no t prove to be an independent predictor of early survival. The presence of tamponade was statistically linked to the mechanism of injury. Tra nsport by non-official conveyance was associated with a higher CVRS on arrival. Intoxication with alcohol or cocaine had no evident effect o n resuscitation probability.