Surgical exploration for stable patients with penetrating cardiac box injuries: when and how? A cohort of 155 patients from Marseille area.
J Trauma Acute Care Surg 2022;
93:394-401. [PMID:
35125446 DOI:
10.1097/ta.0000000000003561]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND
The management of penetrating thoracic injuries in moribund or unstable patients is clearly described in contrast to that of stable patients, particularly for those with a cardiac box injury. This anatomic location suggests a potentially lethal cardiac injury and requires urgent therapeutic decision making. The present study aims at determining when surgical exploration is beneficial for stable patients presenting with penetrating cardiac box injuries (PCBI).
METHODS
This was a retrospective study of stable civilian patients with PCBI referred to level I trauma centers in the Marseille area between January 2009 and December 2019. Using post-hoc analysis of the management outcomes, patients whose surgery was considered therapeutic (group A) were compared with those surgery was considered non-therapeutic and with non-operated patients (group B).
RESULTS
A total of 155 patients with PCBI were included, with 88% (n = 137) of stab wound injuries (SW). Overall, surgical exploration was performed in 54% (n = 83), considered therapeutic in 71% (n = 59), and performed by video-assisted thoracoscopy (VATS) in 42% (n = 35) with a conversion rates of 14% (n = 5). Initial extended Fast Assessment with Sonography for Trauma (eFAST) revealed the presence of hemopericardium in 29% (n = 29) in group A vs 9.5% (n = 7) in group B, p = 0.010, and was associated with a negative predictive value of 93% regarding the presence of a cardiac injury. Chest tube flow was significantly higher in patients who required surgery, with a median (IQR) of 600.00 (350.00, 1200.00) mL vs. 300.0 (150.00, 400.00) mL (p = 0.001).
CONCLUSION
eFAST and chest tube flow are the cornerstones of the management of stable PCBI. Video-assisted thoracoscopy represents an interesting approach to check intra thoracic wounds while minimizing surgical morbidity.
LEVEL OF EVIDENCE
Level IV, prognostic study.
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