USE OF CARDIOPULMONARY BYPASS TO SALVAGE PATIENTS WITH MULTIPLE-CHAMBER HEART WOUNDS

Background: The need for cardiopulmonary bypass in the treatment of pe netrating heart injuries is debated. Objectives: To review our experie nce with penetrating heart injuries and determine the indications and outcome for cardiopulmonary bypass. Design: Retrospective review. Sett ing: A university-based, level I trauma center. Patients: All victims of penetrating heart injury presenting between July 1, 1989, and Decem ber 31, 1995. Methods;: Medical records were reviewed for demographic and physiological data, operative findings, and outcome. Results: Over all survival for 106 patients with penetrating heart injury was 55%. I n an effort to resuscitate the heart, 4 patients with unresponsive car diogenic shock were placed on cardiopulmonary bypass; none survived. O f 30 patients with multiple-chamber injuries, 11 presented with signs of life and 7 survived. Cardiopulmonary bypass was essential to repair complex injuries in 2 of the 7 survivors. Conclusion: Cardiopulmonary bypass was ineffective in salvaging patients with cardiogenic shock b ut was essential in some patients with complex multiple-chamber cardia c injuries that could not be exposed and repaired by other means.