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Omoto K, Tanaka C, Fukuda R, Tagami T, Unemoto K. Comparison of the effectiveness of pericardiocentesis and surgical pericardiotomy in the prognosis of patients with blunt traumatic cardiac tamponade: a multicenter study using the Japan Trauma Data Bank. Acute Med Surg 2022; 9:e768. [PMID: 35769387 PMCID: PMC9209333 DOI: 10.1002/ams2.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/29/2022] [Indexed: 11/11/2022] Open
Abstract
Aim To compare the prognostic impact of pericardiocentesis (PCC) and surgical pericardiotomy (SP) in blunt traumatic pericardial tamponade. Methods Among 361,706 trauma patients registered in the Japan Trauma Data Bank from January 2004 to December 2018, we included those with blunt traumatic cardiac tamponade who underwent PCC and/or SP. We excluded patients with penetrating trauma, age younger than 15 years, Injury Severity Score (ISS) equal to 75, blood pressure 0 mmHg at the time of admission, head Abbreviated Injury Scale (AIS) score 5 or more, and those with missing data for outcomes. To examine the effect of SP, patients were divided into a PCC group and an SP‐only group. Missing values of age, sex, systolic blood pressure, respiratory rate, pulse rate, time from emergency call to hospital arrival, head AIS, chest AIS, abdomen/pelvis AIS, Glasgow Coma Scale score, and ISS were estimated using multiple imputation. In‐hospital mortality was analyzed using multivariable analysis, and we undertook a survival analysis. Results We analyzed 305 patients, 150 (49.2%) in the PCC group and 155 (50.8%) in the SP‐only group. The in‐hospital mortality rate was 40.7% in the PCC group and 76.8% in the SP‐only group. Multivariable analysis after multiple imputation showed an odds ratio of SP for in‐hospital mortality 5.34 (95% confidence interval, 2.80–10.18; P < 0.01) compared with PCC. Using the Kaplan–Meier method, SP showed a significant risk of mortality (hazard ratio 2.16; 95% confidence interval, 1.58–2.95; P < 0.01). Conclusions In patients with blunt traumatic cardiac tamponade, SP was associated with poor prognosis.
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Affiliation(s)
- Kenichiro Omoto
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| | - Chie Tanaka
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine Nippon Medical School Musashikosugi Hospital Kawasaki Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
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Moroni F, Brilakis ES, Azzalini L. Chronic total occlusion percutaneous coronary intervention: managing perforation complications. Expert Rev Cardiovasc Ther 2021; 19:71-87. [PMID: 33175595 DOI: 10.1080/14779072.2021.1850264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Coronary artery perforation (CAP) is an infrequent (<1%) complication of percutaneous coronary intervention (PCI), that can lead to dramatic consequences, including tamponade and death. The incidence of CAP is higher (4-9%) in chronic total occlusion (CTO) PCI due higher complexity of these lesions and the techniques used to recanalized them. AREAS COVERED In this Expert Review, we discuss the specific features of CTO PCI predisposing to CAP. We also describe the typical procedural scenarios in which CAP can occur and provide a universal management algorithm. Currently available devices and techniques for CAP treatment are presented in detail. Finally, we discuss imaging support for diagnosis of pericardial effusion in CAP as well as medical and surgical management. EXPERT OPINION With increasing volumes and complexity of CTO PCI, the incidence of CAP is likely to rise. Adherence to good catheterization laboratory practices, availability of dedicated equipment to seal CAP, perform pericardiocentesis, and provide hemodynamic support, as well as adequate training, are pillars for the prevention and optimal management of CAP during CTO PCI.
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Affiliation(s)
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University , Richmond, VA, USA
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Sumann G, Moens D, Brink B, Brodmann Maeder M, Greene M, Jacob M, Koirala P, Zafren K, Ayala M, Musi M, Oshiro K, Sheets A, Strapazzon G, Macias D, Paal P. Multiple trauma management in mountain environments - a scoping review : Evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Intended for physicians and other advanced life support personnel. Scand J Trauma Resusc Emerg Med 2020; 28:117. [PMID: 33317595 PMCID: PMC7737289 DOI: 10.1186/s13049-020-00790-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Multiple trauma in mountain environments may be associated with increased morbidity and mortality compared to urban environments. Objective To provide evidence based guidance to assist rescuers in multiple trauma management in mountain environments. Eligibility criteria All articles published on or before September 30th 2019, in all languages, were included. Articles were searched with predefined search terms. Sources of evidence PubMed, Cochrane Database of Systematic Reviews and hand searching of relevant studies from the reference list of included articles. Charting methods Evidence was searched according to clinically relevant topics and PICO questions. Results Two-hundred forty-seven articles met the inclusion criteria. Recommendations were developed and graded according to the evidence-grading system of the American College of Chest Physicians. The manuscript was initially written and discussed by the coauthors. Then it was presented to ICAR MedCom in draft and again in final form for discussion and internal peer review. Finally, in a face-to-face discussion within ICAR MedCom consensus was reached on October 11th 2019, at the ICAR fall meeting in Zakopane, Poland. Conclusions Multiple trauma management in mountain environments can be demanding. Safety of the rescuers and the victim has priority. A crABCDE approach, with haemorrhage control first, is central, followed by basic first aid, splinting, immobilisation, analgesia, and insulation. Time for on-site medical treatment must be balanced against the need for rapid transfer to a trauma centre and should be as short as possible. Reduced on-scene times may be achieved with helicopter rescue. Advanced diagnostics (e.g. ultrasound) may be used and treatment continued during transport.
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Affiliation(s)
- G Sumann
- Austrian Society of Mountain and High Altitude Medicine, Emergency physician, Austrian Mountain and Helicopter Rescue, Altach, Austria
| | - D Moens
- Emergency Department Liège University Hospital, CMH HEMS Lead physician and medical director, Senior Lecturer at the University of Liège, Liège, Belgium
| | - B Brink
- Mountain Emergency Paramedic, AHEMS, Canadian Society of Mountain Medicine, Whistler Blackcomb Ski Patrol, Whistler, Canada
| | - M Brodmann Maeder
- Department of Emergency Medicine, University Hospital and University of Bern, Switzerland and Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - M Greene
- Medical Officer Mountain Rescue England and Wales, Wales, UK
| | - M Jacob
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Hospitallers Brothers Saint-Elisabeth-Hospital Straubing, Bavarian Mountain Rescue Service, Straubing, Germany
| | - P Koirala
- Adjunct Assistant Professor, Emergency Medicine, University of Maryland School of Medicine, Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | - K Zafren
- ICAR MedCom, Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA, USA.,Alaska Native Medical Center, Anchorage, AK, USA
| | - M Ayala
- University Hospital Germans Trias i Pujol, Badalona, Spain
| | - M Musi
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - K Oshiro
- Department of Cardiovascular Medicine and Director of Mountain Medicine, Research, and Survey Division, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - A Sheets
- Emergency Department, Boulder Community Health, Boulder, CO, USA
| | - G Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.,The Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School (CNSAS SNaMed), Milan, Italy
| | - D Macias
- Department of Emergency Medicine, International Mountain Medicine Center, University of New Mexico, Albuquerque, NM, USA
| | - P Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria.
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Ijuin S, Inoue A, Takamiyagi Y, Tsukayama H, Nakayama H, Matsuyama S, Kawase T, Ishihara S, Nakayama S. False negative of pericardial effusion using focused assessment with sonography for trauma and enhanced CT following traumatic cardiac rupture; A case report. Trauma Case Rep 2020; 28:100327. [PMID: 32671173 PMCID: PMC7350087 DOI: 10.1016/j.tcr.2020.100327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background The focused assessment with sonography for trauma (FAST) examination is helpful for the identification of pericardial effusion in trauma. However, in a cardiac rupture with a pericardial perforation, pericardial effusion is not always detected by FAST. We experienced the case that FAST and enhanced CT failed to detect pericardial effusion. Case presentation A 51-year old woman injured after falling from a height of 3 m was brought to our institute. Focused assessment with sonography for trauma and enhanced computed tomography did not reveal any pericardial effusion; however, a massive hemothorax was revealed. Because the patient's hemodynamic state had become unstable, we performed an urgent left anterolateral thoracotomy. A left pericardial perforation was detected. By performing a clamshell thoracotomy, we found a rupture of 1 cm in diameter at the left atrial appendage. The hemodynamic state was stabilized by suturing the injury site. The postoperative course was uneventful, and the patient was transferred to another hospital after 31 days of admission. Conclusions Cardiac injury in the left atrial appendage is rare and sometimes difficult to diagnose and to repair. In the case of a blunt chest trauma with a massive hemothorax, although focused assessment with sonography for trauma gives negative results for pericardial effusion, a cardiac rupture with pericardial perforation should be considered.
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Affiliation(s)
- Shinichi Ijuin
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Yoei Takamiyagi
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Hiroyuki Tsukayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Haruki Nakayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Shigenari Matsuyama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Tetsunori Kawase
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
| | - Shinichi Nakayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan
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Tanizaki S, Nishida S, Maeda S, Ishida H. Non-surgical management in hemodynamically unstable blunt traumatic pericardial effusion: A feasible option for treatment. Am J Emerg Med 2018; 36:1655-1658. [PMID: 29980487 DOI: 10.1016/j.ajem.2018.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Little is known about the outcomes of deliberate non-surgical management for hemodynamically unstable patients with blunt traumatic pericardial effusion. We evaluated the efficacy of management with pericardiocentesis or subxiphoid pericardial window in hemodynamically unstable patients who reach the hospital alive with blunt traumatic pericardial effusion. METHODS We conducted a review of a consecutive series of patients with pericardial effusion following blunt trauma who arrived at Fukui Prefectural Hospital between January 1, 2009 and December 31, 2017. All patients with traumatic pericardial effusion were included, irrespective of the type of blunt trauma. RESULTS Eleven patients were identified arrived to the Emergency Department with a pericardial effusion after blunt trauma. Of the eleven patients, five patients had cardiopulmonary arrest on arrival and none survived. Of the other six patients who reached the hospital alive, five were hemodynamically unstable and clinically diagnosed with cardiac tamponade. One patient was hemodynamically stable and managed conservatively without pericardiocentesis or pericardial window. Otherwise, two patients were managed with pericardiocentesis alone. One patient was managed with pericardial window alone. One was managed with both pericardiocentesis and pericardial window. The remaining patient underwent median sternotomy because of unsuccessful pericardial drainage tube insertion. All six patients who reached the hospital alive survived. Five patients did not require surgical repair. CONCLUSION The results of the present study suggested that non-surgical management of hemodynamically unstable patients who reach hospital alive with blunt pericardial effusion may be a feasible option for treatment.
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Affiliation(s)
- Shinsuke Tanizaki
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
| | - Satoru Nishida
- Department of Cardiovascular Surgery, Fukui Prefectural Hospital, Fukui, Japan
| | - Shigenobu Maeda
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Hiroshi Ishida
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
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Huang JF, Hsieh FJ, Fu CY, Liao CH. Non-operative management is feasible for selected blunt trauma patients with pericardial effusion. Injury 2018; 49:20-26. [PMID: 29191668 DOI: 10.1016/j.injury.2017.11.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/14/2017] [Accepted: 11/25/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Blunt pericardial effusion (BPE) in trauma patients can be suggestive of injuries to the heart or great vessels. Surgical exploration is the mainstay of management; however, the effectiveness of non-operative management in this patient group remains unclear. METHODS Patients presenting with BPE in the trauma registry system at our level I trauma center were reviewed. Patients with and without cardiovascular (CVS) injury were compared to identify predictors for CVS injury and to understand the factors related to the requirement for surgery. Patients with and without CVS injury who presented with stable hemodynamics and initially received conservative management were also compared. RESULTS Thirty patients were enrolled in the study with a mean age of 53.2 (standard deviation (SD) 18.0) years and a mean injury severity score (ISS) of 26.7 (SD 9.0). Eleven patients presented with systolic blood pressure (SBP)<100mmHg, and immediate surgical intervention was performed. Eight patients had evidence of CVS injury (73%). Nineteen patients had stable hemodynamics and initially received conservative treatment. Of these, twelve patients received further surgical interventions, and only three had evidence of CVS injury (16%, 3/19). Comparisons of individuals with and without CVS injury revealed that the SBP on presentation was higher in patients without CVS injury than in those with CVS injury (132.7 (SD 41.3) mmHg vs. 95.6 (SD 21.1) mmHg). Clinically irrelevant differences between the two groups were observed for the creatine kinase (CK)-MB level, the troponin I level, the presence of an echocardiography tamponade sign, associated chest trauma and ISS. No remarkable predictors for CVS injury were found in hemodynamically stable patients. CONCLUSION Non-operative management can be considered for patents with traumatic BPE and stable hemodynamics; however, this approach must be performed at an institution with adequate facilities and well-trained staff.
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Affiliation(s)
- Jen-Fu Huang
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Feng-Jen Hsieh
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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Abstract
BACKGROUND The incidence of cardiac injury in immediate fatalities after blunt trauma remains underestimated, and reliable diagnostic strategies are still missing. Furthermore, clinical data concerning heart-specific troponin serum levels, injury severity score (ISS), catecholamine treatment and survival of patients on admission to the hospital have rarely been interrelated so far. Therefore, the object of the present study was to identify predictive parameters for mortality in the context of blunt cardiac injury. METHODS This retrospective observational study included 173 severely injured patients with an ISS ≥25 admitted to the University Hospital of Ulm, a level 1 trauma center, during 2009-2013 . Furthermore, 83 blunt trauma victims who died before hospital admission were subjected to postmortem examination at the Institute of Legal Medicine, University of Ulm, during 2009-2014. ISS, cardiac injury and associated thoracic injuries were determined in both groups. Furthermore, in the hospitalized patients, serum troponin and IL-6 levels were measured. RESULTS Macroscopic heart injury was observed in 18 % of the patients who died at the scene and only in 1 % of the patients admitted to the hospital, indicating that macroscopic heart injury is associated with an immediate life-threatening condition. Troponin levels were elevated in 43 % of the patients after admission to the hospital. Moreover, troponin serum concentrations were significantly higher in patients treated with norepinephrine (26.4 ± 4 ng/l) and in non-survivors (84.9 ± 22.8 ng/l) compared to patients without catecholamines and survivors, respectively. CONCLUSIONS Macroscopic heart injury was 20 times more frequent in non-survivors than in survivors. Serum troponin levels correlated with mortality after multiple injury and therefore may represent a valuable prognostic marker in trauma patients.
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Management of pericardial fluid in blunt trauma: Variability in practice and predictors of operative outcome in patients with computed tomography evidence of pericardial fluid. J Trauma Acute Care Surg 2017; 82:733-741. [PMID: 28129264 DOI: 10.1097/ta.0000000000001386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The objectives of this study were to assess current variability in management preferences for blunt trauma patients with pericardial fluid, and to identify characteristics associated with operative intervention for patients with pericardial fluid on admission computed tomography (CT) scan. METHODS This was a mixed-methods study of blunt trauma patients with pericardial fluid. The first portion was a research survey of members of the Eastern Association for the Surgery of Trauma conducted in 2016, in which surgeons were presented with four clinical scenarios of blunt trauma patients with pericardial fluid. The second portion of the study was a retrospective evaluation of all blunt trauma patients 14 years or older treated at our Level I trauma center between January 1, 2010, and November 1, 2015, with pericardial fluid on admission CT scan. RESULTS For the survey portion of our study, 393 surgeons responded (27% response rate). There was significant variability in management preferences for scenarios depicting trace pericardial fluid on CT with concerning hemodynamics, and for scenarios depicting hemopericardium intraoperatively. For the separate retrospective portion of our study, we identified 75 blunt trauma patients with pericardial fluid on admission CT scan. Seven underwent operative management; six of these had hypotension and/or electrocardiogram changes. In multivariable analysis, pericardial fluid amount was a significant predictor of receiving pericardial window (relative risk for one category increase in pericardial fluid amount, 3.99, 95% confidence interval, 1.47-10.81) but not of mortality. CONCLUSION There is significant variability in management preferences for patients with pericardial fluid from blunt trauma, indicating a need for evidence-based research. Our institutional data suggest that patients with minimal to small amounts of pericardial fluid without concerning clinical findings may be observed. Patients with moderate to large amounts of pericardial fluid who are clinically stable with normal hemodynamics may also appear appropriate for observation, although confirmation in larger studies is needed. Patients with hemodynamic instability should undergo operative exploration. LEVEL OF EVIDENCE Therapeutic/care management study, level IV.
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Broch O, Renner J, Meybohm P, Albrecht M, Höcker J, Haneya A, Steinfath M, Bein B, Gruenewald M. Dynamic Variables Fail to Predict Fluid Responsiveness in an Animal Model With Pericardial Effusion. J Cardiothorac Vasc Anesth 2016; 30:1205-11. [PMID: 27499343 DOI: 10.1053/j.jvca.2016.03.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The reliability of dynamic and volumetric variables of fluid responsiveness in the presence of pericardial effusion is still elusive. The aim of the present study was to investigate their predictive power in a porcine model with hemodynamic relevant pericardial effusion. DESIGN A single-center animal investigation. PARTICIPANTS Twelve German domestic pigs. INTERVENTIONS Pigs were studied before and during pericardial effusion. Instrumentation included a pulmonary artery catheter and a transpulmonary thermodilution catheter in the femoral artery. Hemodynamic variables like cardiac output (COPAC) and stroke volume (SVPAC) derived from pulmonary artery catheter, global end-diastolic volume (GEDV), stroke volume variation (SVV), and pulse-pressure variation (PPV) were obtained. MEASUREMENTS AND MAIN RESULTS At baseline, SVV, PPV, GEDV, COPAC, and SVPAC reliably predicted fluid responsiveness (area under the curve 0.81 [p = 0.02], 0.82 [p = 0.02], 0.74 [p = 0.07], 0.74 [p = 0.07], 0.82 [p = 0.02]). After establishment of pericardial effusion the predictive power of dynamic variables was impaired and only COPAC and SVPAC and GEDV allowed significant prediction of fluid responsiveness (area under the curve 0.77 [p = 0.04], 0.76 [p = 0.05], 0.83 [p = 0.01]) with clinically relevant changes in threshold values. CONCLUSIONS In this porcine model, hemodynamic relevant pericardial effusion abolished the ability of dynamic variables to predict fluid responsiveness. COPAC, SVPAC, and GEDV enabled prediction, but their threshold values were significantly changed.
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Affiliation(s)
- Ole Broch
- Departments of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
| | - Jochen Renner
- Departments of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Patrick Meybohm
- Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital, Frankfurt, Germany
| | - Martin Albrecht
- Experimental Anesthesiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Jan Höcker
- Departments of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Assad Haneya
- Cardiothoracic and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Markus Steinfath
- Departments of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Berthold Bein
- Anesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Matthias Gruenewald
- Departments of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Alvarado C, Vargas F, Guzmán F, Zárate A, Correa JL, Ramírez A, Quintero DM, Ramírez EM. Trauma cardiaco cerrado. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Baxi AJ, Restrepo C, Mumbower A, McCarthy M, Rashmi K. Cardiac Injuries: A Review of Multidetector Computed Tomography Findings. Trauma Mon 2015; 20:e19086. [PMID: 26839855 PMCID: PMC4727463 DOI: 10.5812/traumamon.19086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 06/12/2014] [Accepted: 07/12/2014] [Indexed: 01/15/2023] Open
Abstract
Trauma is the leading cause of death in United States in the younger population. Cardiac trauma is common following blunt chest injuries and is associated with high morbidity and mortality. This study discusses various multidetector computed tomography (MDCT) findings of cardiac trauma. Cardiac injuries are broadly categorized into the most commonly occurring blunt cardiac injury and the less commonly occurring penetrating injury. Signs and symptoms of cardiac injury can be masked by the associated injuries. Each imaging modality including chest radiographs, echocardiography, magnetic resonance imaging and MDCT has role in evaluating these patients. However, MDCT is noninvasive; universally available and has a high spatial, contrast, and temporal resolution. It is a one stop shop to diagnose and evaluate complications of cardiac injury. MDCT is an imaging modality of choice to evaluate patients with cardiac injuries especially the injuries capable of causing hemodynamic instability.
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Affiliation(s)
- Ameya Jagdish Baxi
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
- Corresponding author: Ameya Jagdish Baxi, Department of Radiology, University of Texas Health Science Center, San Antonio, USA. Tel: +1-2105675535, E-mail:
| | - Carlos Restrepo
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Amy Mumbower
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Michael McCarthy
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
| | - Katre Rashmi
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
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Chen SW, Huang YK, Liao CH, Wang SY. Right massive haemothorax as the presentation of blunt cardiac rupture: the pitfall of coexisting pericardial laceration. Interact Cardiovasc Thorac Surg 2013; 18:245-6. [PMID: 24218497 DOI: 10.1093/icvts/ivt483] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 74-year old female was transferred to our institution because of blunt chest trauma. Chest X-ray and computed tomography (CT) revealed right haemothorax and little pericardial effusion. She was taken to the operating theatre for emergent operation because of hypotension and massive bleeding from the right-sided chest tube. Cardiopulmonary resuscitation was started during surgical exploration. There were three 1-cm lacerations actively bleeding from the right atrium and inferior vena cava junction, which were repaired successfully. Furthermore, we identified a 10 cm laceration in the right-side pleuropericardium and a communication existing between the pericardial space and the right pleural space.
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Affiliation(s)
- Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther 2013; 93:186-96. [PMID: 22879442 PMCID: PMC3563027 DOI: 10.2522/ptj.20110417] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bed rest and immobility in patients on mechanical ventilation or in an intensive care unit (ICU) have detrimental effects. Studies in medical ICUs show that early mobilization is safe, does not increase costs, and can be associated with decreased ICU and hospital lengths of stay (LOS). OBJECTIVE The purpose of this study was to assess the effects of an early mobilization protocol on complication rates, ventilator days, and ICU and hospital LOS for patients admitted to a trauma and burn ICU (TBICU). DESIGN This was a retrospective cohort study of an interdisciplinary quality-improvement program. METHODS Pre- and post-early mobility program patient data from the trauma registry for 2,176 patients admitted to the TBICU between May 2008 and April 2010 were compared. RESULTS No adverse events were reported related to the early mobility program. After adjusting for age and injury severity, there was a decrease in airway, pulmonary, and vascular complications (including pneumonia and deep vein thrombosis) post-early mobility program. Ventilator days and TBICU and hospital lengths of stay were not significantly decreased. LIMITATIONS Using a historical control group, there was no way to account for other changes in patient care that may have occurred between the 2 periods that could have affected patient outcomes. The dose of physical activity both before and after the early mobility program were not specifically assessed. CONCLUSIONS Early mobilization of patients in a TBICU was safe and effective. Medical, nursing, and physical therapy staff, as well as hospital administrators, have embraced the new culture of early mobilization in the ICU.
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Traumatic mitral valve and pericardial injury. Case Rep Crit Care 2013; 2013:385670. [PMID: 24829821 PMCID: PMC4010058 DOI: 10.1155/2013/385670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 07/06/2013] [Indexed: 11/18/2022] Open
Abstract
Cardiac injury after blunt trauma is common but underreported. Common cardiac trauma after the blunt chest injury (BCI) is cardiac contusion; it is very rare to have cardiac valve injury. The mitral valve injury during chest trauma occurs when extreme pressure is applied at early systole during the isovolumic contraction between the closure of the mitral valve and the opening of the aortic valve. Traumatic mitral valve injury can involve valve leaflet, chordae tendineae, or papillary muscles. For the diagnosis of mitral valve injury, a high index of suspicion is required, as in polytrauma patients, other obvious severe injuries will divert the attention of the treating physician. Clinical picture of patients with mitral valve injury may vary from none to cardiogenic shock. The echocardiogram is the main diagnostic modality of mitral valve injuries. Patient's clinical condition will dictate the timing and type of surgery or medical therapy. We report a case of mitral valve and pericardial injury in a polytrauma patient, successfully treated in our intensive care unit.
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Does hemopericardium after chest trauma mandate sternotomy? J Trauma Acute Care Surg 2012; 72:1518-24; discussion 1524-5. [PMID: 22695415 DOI: 10.1097/ta.0b013e318254306e] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, three patients with hemopericardium after severe chest trauma were successfully managed nonoperatively at our institution. This prompted the question whether these were rare or common events. Therefore, we reviewed our experience with similar injuries to test the hypothesis that trauma-induced hemopericardium mandates sternotomy. METHOD Records were retrospectively reviewed for all patients at a Level I trauma center (December 1996 to November 2011) who sustained chest trauma with pericardial window (PCW, n = 377) and/or median sternotomy (n = 110). RESULTS Fifty-five (15%) patients with positive PCW proceeded to sternotomy. Penetrating injury was the dominant mechanism (n = 49, 89%). Nineteen (35%) were hypotensive on arrival or during initial resuscitation. Most received surgeon-performed focused cardiac ultrasound examinations (n = 43, 78%) with positive results (n = 25, 58%). Ventricular injuries were most common, with equivalent numbers occurring on the right (n = 16, 29%) and left (n = 15, 27%). Six (11%) with positive PCW had isolated pericardial lacerations, but 21 (38%) had no repairable cardiac or great vessel injury. Those with therapeutic versus nontherapeutic sternotomies were similar with respect to age, mechanisms of injury, injury severity scores, presenting laboratory values, resuscitation fluids, and vital signs. Multiple logistic regression revealed that penetrating trauma (odds ratio: 13.3) and hemodynamic instability (odds ratio: 7.8) were independent predictors of therapeutic sternotomy. CONCLUSION Hemopericardium per se may be overly sensitive for diagnosing cardiac or great vessel injuries after chest trauma. Some stable blunt or penetrating trauma patients without continuing intrapericardial bleeding had nontherapeutic sternotomies, suggesting that this intervention could be avoided in selected cases. LEVEL OF EVIDENCE Therapeutic study, level III.
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Mirka H, Ferda J, Baxa J. Multidetector computed tomography of chest trauma: indications, technique and interpretation. Insights Imaging 2012; 3:433-49. [PMID: 22865481 PMCID: PMC3443276 DOI: 10.1007/s13244-012-0187-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 07/10/2012] [Indexed: 12/28/2022] Open
Abstract
Background Chest traumas are a significant cause of mortality and morbidity, especially in the younger population.MethodsDiagnostic imaging plays a key role in their management. Multidetector computed tomography (MDCT) is the most important imaging method in this field. Its advantages include especially high speed and high geometric resolution in any plane.ResultsThe method allows us to view large parts of the body with minimal motion artifacts and to create accurate multiplanar and three-dimensional (3D) reformations, which make the diagnosis significantly more accurate. Because of its advantages MDCT has become the first-choice method in high-energy traumas.ConclusionThis article summarises the position of MDCT in the diagnostic algorithm of chest injuries, technical aspects of the examination and imaging findings in traumas of the individual chest compartments. Teaching Points • Diagnostic imaging plays a key role in the management of high-energy chest trauma. • MDCT is the most important imaging method in this kind of injury, as detailed information can be acquired in a short acquisition time. • Multiplanar and three-dimensional (3D) reformattings make the diagnosis significantly more accurate.
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Affiliation(s)
- Hynek Mirka
- Department of Imaging methods, Charles University and University Hospital in Pilsen, Alej Svobody 80, 304 60, Pilsen, Czech Republic,
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Re. J Trauma Acute Care Surg 2012. [DOI: 10.1097/ta.0b013e3182580c3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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