PENETRATING CARDIAC INJURIES - A PROSPECTIVE-STUDY OF VARIABLES PREDICTING OUTCOMES

Background: Penetrating cardiac injuries are one of the leading causes of death from urban violence. Study Design: This is a prospective, 1- year study in a Level I Trauma Center with the objective of analyzing: (1) the parameters measuring the physiologic condition of patients su staining penetrating cardiac injuries in the field during transport an d on arrival, (2) the cardiovascular-respiratory score (CVRS) componen t of the trauma score, (3) the mechanism and anatomic site of injury, (4) the presence or absence of tamponade, and (5) the cardiac rhythm a s a predictor of outcomes. We attempted to correlate cardiac injury gr ade (AAST-OIS) with mortality. Our main intervention was thoracotomy f or resuscitation and definitive repair of cardiac injury. Main outcome s measures were all parameters measuring the physiologic condition of patients, CVRS, mechanism and anatomic site of injury, operative findi ngs and maneuvers, mortality, and grade of injury. Results: The study consisted of 60 patients sustaining penetrating cardiac injuries, 35 g unshot wound (58%) and 25 stab wounds (42%). The injury severity score (ISS) was > 30 in 22 patients; overall survival was 22 of 60 (36.6%); gunshot wound (GSW) survival, 5 of 35 (14%); and stab wound (SW) surv ival, 17 of 25 (68%). An emergency department thoracotomy was performe d in 37 of 60 (61.7%) with 6 of 37 survivors (16%). CVRS: 96% mortalit y (25 of 26) when CVRS = 0.67% mortality (6 of 9) when CVRS = 1-3; and 25% mortality (7 of 25) when CVRS > 4 (p < 0.001). Mechanism of injur y, and presence of sinus rhythm when pericardium opened predict outcom es (p < 0.001). Anatomic site of injury and tamponade do not predict o utcomes (not significant). AAST-OIS injury grade and mortality: grade IV, 31 of 60 (52%); grade V, 20 of 60 (75%), and grade VI, 6 of 60 (10 0%). Conclusions: Parameters measuring physiologic condition, CVRS, an d mechanism of injury plus initial rhythm are significant predictors o f outcomes in penetrating cardiac injuries. The need for aortic crossc lamping and the inability to restore an organized rhythm or blood pres sure after thoracotomy were also predictors of outcomes. The presence of pericardial tamponade was not. (C) 1998 by the American College of Surgeons.