Jin-Mou Gao1,2, Ding-Yuan Du3,4, Ling-Wen Kong3, Jun Yang4, Hui Li4, Gong-Bin Wei4, Chang-Hua Li4, Chao-Pu Liu4. 1. Department of Cardiothoracic Surgery, Central Affiliated Hospital of Chongqing University, Chongqing Emergency Medical Center, Chongqing, 400014, China. gaojinmou2002@sina.com. 2. Department of Traumatology, Central Affiliated Hospital of Chongqing University, Chongqing Emergency Medical Center, Chongqing, 400014, China. gaojinmou2002@sina.com. 3. Department of Cardiothoracic Surgery, Central Affiliated Hospital of Chongqing University, Chongqing Emergency Medical Center, Chongqing, 400014, China. 4. Department of Traumatology, Central Affiliated Hospital of Chongqing University, Chongqing Emergency Medical Center, Chongqing, 400014, China.
Abstract
BACKGROUND: Blunt cardiac injury (BCI) increases with traffic accidents and is an important cause of death in trauma patients. In particular, for patients who need surgical treatment, the mortality rate is extremely high unless the patient is promptly operated on. This study aimed to explore early recognition and expeditious surgical intervention to increase survival. METHODS: All patients with BCIs during the past 15 years were reviewed, and those who underwent operative treatment were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. RESULTS: A total of 348 patients with BCIs accounted for 18.3% of 1903 patients with blunt thoracic injury (BTI). Of 348 patients, 43 underwent operative treatment. The main cause of injury was traffic accidents, with an incidence of 48.8%. Of them, steering wheel injuries occurred in 15 patients. In 26 patients, a preoperative diagnosis was obtained by echocardiography, CT scanning, etc. In the remaining 17, who had to undergo urgent thoracotomy without any preoperative imaging, a definitive diagnosis of BCI was proven during the operation. The volume of preoperative infusion or crystalloid was <1000 ml in 31 cases. Preoperative pericardiocentesis was not used in anyone. In 12 patients, the operation commenced within 1 h. Overall mortality was 32.6%. The death was caused by BCI in 9. CONCLUSIONS: Facing a patient with BTI, a high index of suspicion for BCI must be maintained. To manage those requiring operations, early recognition and expeditious thoracotomy are essential. Preoperatively, limited fluid resuscitation is emphasized. We do not advocate preoperative pericardiocentesis.
BACKGROUND: Blunt cardiac injury (BCI) increases with traffic accidents and is an important cause of death in traumapatients. In particular, for patients who need surgical treatment, the mortality rate is extremely high unless the patient is promptly operated on. This study aimed to explore early recognition and expeditious surgical intervention to increase survival. METHODS: All patients with BCIs during the past 15 years were reviewed, and those who underwent operative treatment were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. RESULTS: A total of 348 patients with BCIs accounted for 18.3% of 1903 patients with blunt thoracic injury (BTI). Of 348 patients, 43 underwent operative treatment. The main cause of injury was traffic accidents, with an incidence of 48.8%. Of them, steering wheel injuries occurred in 15 patients. In 26 patients, a preoperative diagnosis was obtained by echocardiography, CT scanning, etc. In the remaining 17, who had to undergo urgent thoracotomy without any preoperative imaging, a definitive diagnosis of BCI was proven during the operation. The volume of preoperative infusion or crystalloid was <1000 ml in 31 cases. Preoperative pericardiocentesis was not used in anyone. In 12 patients, the operation commenced within 1 h. Overall mortality was 32.6%. The death was caused by BCI in 9. CONCLUSIONS: Facing a patient with BTI, a high index of suspicion for BCI must be maintained. To manage those requiring operations, early recognition and expeditious thoracotomy are essential. Preoperatively, limited fluid resuscitation is emphasized. We do not advocate preoperative pericardiocentesis.
Authors: Jasmeet Soar; Gavin D Perkins; Gamal Abbas; Annette Alfonzo; Alessandro Barelli; Joost J L M Bierens; Hermann Brugger; Charles D Deakin; Joel Dunning; Marios Georgiou; Anthony J Handley; David J Lockey; Peter Paal; Claudio Sandroni; Karl-Christian Thies; David A Zideman; Jerry P Nolan Journal: Resuscitation Date: 2010-10 Impact factor: 5.262