Analysis of 285 cardiac penetrating injuries in the Lebanon war.

This study evaluates factors influencing survival in 285 battle cardiac injuries, treated in Lebanon from 1969 to 1982. Survival factors included age (mean 18 years), transportation lag (mean distance 2 miles), wounding agents (shrapnel, gunshot), hospital logistics, and early surgical treatment. The overall survival was 73% (208 patients) compared to 60% from World War II and 67% from recent civilian report. Treatment logistics included a specialized centre with ambulance radio communication. The state of shock at arrival influenced survival: 146 of 188 patients with mild shock survived (78%) with 61% (53 patients) survival in the profound shock group, treated similarly. The site of cardiac injury influenced outcome. Survival was best in the 9 patients with coronary vessel wounds (100%), atrial wounds 80% (56 survivors) but dropped to 46% (17 survivors) in left ventricular injury reflecting pump failure, and 51% (19 survivors) in multiple cardiac wounds. The causes of cardiac mortality and survivor follow-up were evaluated. The study indicates that despite predetermined factors overall survival is significantly improved by early transportation, precise logistics, and urgent surgery.