J. A. Enriquez3, R. M. Clark1, B. B. Coffman2, S. W. Lu1, S. D. West1, M. Wang1, T. R. Howdieshell1 1University Of New Mexico HSC,Department Of Surgery,Albuquerque, NM, USA 2University Of New Mexico HSC,Department Of Pathology,Albuquerque, NM, USA 3University Of New Mexico HSC,School Of Medicine,Albuquerque, NM, USA
Introduction:
Penetrating cardiac trauma is a devastating injury associated with high morbidity and mortality. Modern imaging techniques such as ultrasound (Focused Assessment with Sonography for Trauma, FAST) and computed tomography (CT) have changed the way penetrating cardiac trauma patients are evaluated while operative methods have remained relatively unchanged. Rural trauma centers are uniquely poised to explore the natural history of these injuries including the likelihood of survival after prolonged prehospital transfer.
Methods:
A retrospective review of a prospectively maintained comprehensive trauma database was conducted of all penetrating cardiac injuries treated at our center spanning a 10-year period. Medical records were abstracted to gather patient demographics, medical comorbidities, presentation, type and anatomic location of injury, trauma bay resuscitation, operative intervention and outcomes including survival and complications. Data were compiled using RedCap database software and descriptive statistics were generated. Comparisons were evaluated using either Chi square or Students t test analysis.
Results:
During the study period, our center treated a total of 102 patients with penetrating cardiac injuries. Twenty-four percent of subjects were transferred from rural locations within the region with 95% of rural patients surviving to hospital discharge. Stab wounds accounted for 63% of injury mechanisms while 33% of patients had gunshot wounds (GSW). The majority of cardiac injuries resulted from wounding within the anatomic cardiac box (89%) with axillary (17%) and periclavicular (8%) wounds being less common. Fifty-two percent of patients underwent real-time FAST examination in the trauma resuscitation area with 49% of FAST scans demonstrating pericardial effusion and 24% of exams deemed negative for abnormality (false negative). CT was used in 21% of cases with cardiac injury (61%), hemothorax (39%) and mediastinal hemorrhage (22%) accounting for the most common radiographic findings. The majority (79%) of patients underwent operative intervention shortly after arrival to the trauma center including 11 emergency resuscitative thoracotomies (11%). Ultimately, 56% of subjects survived to hospital discharge. The vast majority of deaths occurred in the emergency department shortly after arrival.
Conclusion:
The unique geographic arrangement of New Mexico provides an opportunity to understand the natural history of penetrating cardiac trauma and the effects of prehospital management on survival. These data suggest that survival to presentation to a trauma center portends a high likelihood of survival to discharge for injured rural patients. Modern diagnostic techniques include ultrasound examination as well as advanced cross sectional modalities. These procedures demonstrated surprisingly low sensitivity for cardiac injury in our series.