Objective: To determine factors affecting prognosis for patients with penet
rating wounds of the heart.
Methods: A retrospective review of 302 patients with penetrating heart woun
ds undergoing emergency thoracotomy (August of 1980 through June of 1997) i
n a Level I trauma center.
Results: There were 148 patients with gunshot wounds (GSW) and 153 patients
with stab wounds with 23% and 58% survival rates, respectively. Of 43 pati
ents having no signs of life at the scene, 5 patients (12%) achieved some c
ardiac activity and were brought to the operating room (OR), but none survi
ved. Of 67 patients "arresting" in the ambulance, 23 got to the OR, but onl
y 3 patients (4%) survived. Of 27 patients "arresting" in the emergency dep
artment (ED), 18 patients reached the OR, but only 5 patients (19%) survive
d. Of 15 patients having an ED thoracotomy because of rapid deterioration t
here, 4 patients (27%) survived. Thus, of the 152 patients with an ED thora
cotomy, 93 patients had gunshot wounds and none survived; of the 59 with st
ab wounds, 12 (20%) survived (p < 0.001). Of 150 patients having an OR thor
acotomy, 111 (74%) survived. Single-chamber injuries had a survival rate of
51% (112 of 219 patients), but multiple chamber and/or intrapericardial gr
eat vessel injuries had only a 13% survival rate (11 of 83 patients) (p < 0
.001). Intrapericardial aortic injuries were uniformly fatal in 15 patients
. In patients with stab wounds, pericardial tamponade was associated with a
higher survival rate (66%; 56 of 84 patients) than in those without tampon
ade (47%; 33 of 70 patients).
Conclusion: The physiologic status of the patient at presentation, mechanis
m of injury, and presence of a tamponade were significant prognostic factor
s in this series of penetrating cardiac injuries. Multiple-chamber injuries
, especially with great vessel involvement, were associated with a high mor
tality rate. ED thoracotomies for gunshot wounds of the heart were uniforml
y fatal.