Penetrating Cardiac Trauma

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Abstract
During a 10.5 yr interval, 47 patients with penetrating cardiac trauma were managed. Patients (39; 83%) were male. Mean age was 31 yr (range, 13-69). Patients (32; 68%) sustained stab wounds (SW) and 15 patients (32%) gunshot wounds (GSW). Patients (42; 89%) arrived hypotensive (systolic blood pressure less than 90 mm Hg). Patients (27; 57%) had evidence of cardiac tamponade (central venous pressure greater than 15 cm H2O) and 25 of these 27 patients were also in shock. Patients (40; 85%) presented with a normal sinus rhythm and 7 patients (15%) had an idioventricular rhythm or asystole. Overall mortality was 23% (11 of 17 patients). Of the patients sustaining GSW 43% (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. Of the patients in normal sinus rhythm 13% died, while 87% of the patients with idioventricular rhythm or asystole died (P < 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.

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