Penetrating cardiac trauma.

During a 10 1/2 year interval ending in June 1980, 47 patients with penetrating cardiac trauma were managed at The University of Alabama Medical Center. Thirty-nine patients (83%) were male. Mean age was 31 years (range, 13 to 69). Thirty-two patients (68%) sustained stab wounds (SW) and 15 patients (32%) gunshot wounds (GSW). Forty-two patients (89%) arrived hypotensive (systolic blood pressure less than 90 mm Hg). Twenty-seven patients (57%) had evidence of cardiac tamponade (central venous pressure greater than 15 cm H2O) and 25 of these 27 patients were also in shock. Forty patients (85%) presented with a normal sinus rhythm and seven patients (15%) had an idioventricular rhythm or asystole. Overall mortality was 23% (11 of 47 patients). Forty-three per cent of the patients sustaining GSW (6/14) died compared to 17% (5/33) of the patients with SW (p = 0.04). Mortality for the patients in shock was 26% and for those with cardiac tamponade 15%. Mortality was 16% for the patients with both shock and cardiac tamponade. Thirteen per cent of the patients in normal sinus rhythm died, while 87% of the patients with idioventricular rhythm or asystole died (p less than 0.0001). Mortality in penetrating cardiac trauma remains high, particularly in patients with GSW and in those patients presenting with an idioventricular rhythm or asystole.