Use of cardiopulmonary bypass to salvage patients with multiple-chamber heart wounds.

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Abstract
THE SPECIFIC indications for cardiopulmonary bypass (CPB) in patients with penetrating cardiac trauma are not clearly defined. Some reports1 indicate that penetrating heart injuries can be managed without the emergency availability of CPB; other authors2 believe that access to emergency CPB is essential to the survival of some patients. In previous studies,3-5 trauma surgeons managed 98% to 100% of penetrating heart injuries without the use of CPB. Proposed indications for CPB in patients with penetrating heart injuries include supporting a patient during physiological collapse and assisting with the repair of injuries not amenable to simple repair because of anatomical inaccessibility. Physiological reasons for using CPB have been proposed because patients with penetrating heart injuries and advanced hemorrhagic or cardiogenic shock frequently die of hypovolemia, hypothermia, and hypoxemia after their injuries are repaired. Emergency CPB can be used to perfuse and oxygenate the tissues and rewarm patients, thus allowing their heart time to rest and recover. Anatomical reasons for using CPB in the treatment of patients with penetrating heart injury include posterior (dorsal) cardiac injuries,4,6 multiple-chamber cardiac injuries, valve injuries,6 and coronary artery injuries.7