BACKGROUND: Penetrating cardiac injuries (PCI) causing tamponade causes subendocardial ischemia, arrhythmias, and cardiac arrest. Pericardial drainage is an important principle, but where drainage should be performed is debated. We hypothesize that drainage in the emergency department (ED) does not delay definitive repair. METHODS: Over a 16-year period, patients sustaining PCI were reviewed. RESULTS: Seventy-eight patients with PCI survived to the operating room (OR), with 39 undergoing ED thoracotomy. An additional 39 patients underwent pericardial drainage, 17 (44%) in the ED and 22 in the OR. Comparing the ED with OR pericardial drainage groups, they had a similar ED systolic pressure (99 ± 25 vs 99 ± 34), heart rate (103 ± 16 vs 85 ± 37), median time to the OR (20 vs 22 min), and mortality (12% vs 23%). CONCLUSIONS: ED pericardial drainage for PCI did not appear to delay operation and had an acceptably low mortality rate. Pericardial drainage is a viable option for stabilization before definitive surgery when surgical intervention is not immediately available in the hemodynamically marginal patient.
BACKGROUND: Penetrating cardiac injuries (PCI) causing tamponade causes subendocardial ischemia, arrhythmias, and cardiac arrest. Pericardial drainage is an important principle, but where drainage should be performed is debated. We hypothesize that drainage in the emergency department (ED) does not delay definitive repair. METHODS: Over a 16-year period, patients sustaining PCI were reviewed. RESULTS: Seventy-eight patients with PCI survived to the operating room (OR), with 39 undergoing ED thoracotomy. An additional 39 patients underwent pericardial drainage, 17 (44%) in the ED and 22 in the OR. Comparing the ED with OR pericardial drainage groups, they had a similar ED systolic pressure (99 ± 25 vs 99 ± 34), heart rate (103 ± 16 vs 85 ± 37), median time to the OR (20 vs 22 min), and mortality (12% vs 23%). CONCLUSIONS: ED pericardial drainage for PCI did not appear to delay operation and had an acceptably low mortality rate. Pericardial drainage is a viable option for stabilization before definitive surgery when surgical intervention is not immediately available in the hemodynamically marginal patient.
Authors: Vasu Chirumamilla; Kartik Prabhakaran; Petrone Patrizio; John A Savino; Corrado P Marini; Zobair Zoha Journal: Int J Surg Case Rep Date: 2016-04-19