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Czarkowski BR, Byerly SE, Lenart EK, Kerwin AJ, Filiberto DM. Management of Penetrating Cardiac Injuries With Pericardial Window and Drainage in Select Patients. Am Surg 2023; 89:3110-3113. [PMID: 37501310 DOI: 10.1177/00031348231157815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Management of penetrating chest injuries with a positive pericardial window (PW) are presumed cardiac injuries and traditionally result in sternotomy. However, there is some evidence in the literature that select patients can be managed with PW, lavage, and drainage (PWLD). METHODS All patients with penetrating chest trauma who underwent PW and/or sternotomy over a 5-year period were identified. Patients were stratified by operative intervention [PW + sternotomy vs PWLD] and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of therapeutic sternotomy. RESULTS Of the 146 patients who underwent PW and/or sternotomy included in the study, 126 patients underwent PW, 39 underwent sternotomy, and 10 underwent PWLD. There was no difference in demographics, LOS, ICU LOS, vent days, or mortality in patients who underwent PW + sternotomy, compared to patients who underwent PWLD. In the PWLD group, one patient returned to the OR for recurrent pericardial effusion and no patients required sternotomy. Multivariable logistic regression identified ISS as an independent predictor of therapeutic sternotomy (OR 1.160; 95% CI 1.006-1.338, P = .0616). Interestingly, positive FAST, significant CT findings, and trajectory were not predictors of therapeutic sternotomy. There were 7 patients with a left hemothorax and negative FAST found to have a positive PW and cardiac injury mandating sternotomy and repair. CONCLUSION Penetrating cardiac injury can be managed with PWLD in select patients. Positive FAST, significant findings on CT, and trajectory do not mandate sternotomy. A negative FAST in the setting of a hemothorax does not rule out a cardiac injury.
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Affiliation(s)
- Brian R Czarkowski
- Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Saskya E Byerly
- Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Emily K Lenart
- Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Andrew J Kerwin
- Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
| | - Dina M Filiberto
- Department of Surgery, University of Tennessee Health Science Center-Memphis, Memphis, TN, USA
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Morales-Uribe CH, López A, Sepúlveda SM. Manejo conservador del hemopericardio por trauma: reporte de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introducción. El trauma cardíaco penetrante es una patología con alta mortalidad, que alcanza hasta el 94 % en el ámbito prehospitalario y el 58 % en el intrahospitalario. El algoritmo internacional para los pacientes que ingresan con herida precordial, hemodinámicamente estables, es la realización de un FAST subxifoideo o una ventana pericárdica, según la disponibilidad del centro, y de ser positivo se procede con una toracotomía o esternotomía.
Métodos. Se hizo una búsqueda bibliográfica en las bases de datos Medline, Pubmed, Science Direct y UpTodate, usando las palabras claves: “taponamiento cardíaco”, “herida precordial” y “manejo no operatorio”. Se tomaron los datos de la historia clínica y las imágenes, previa autorización del paciente.
Caso clínico. Paciente masculino ingresó con herida en área precordial, estable hemodinámicamente, sin signos de sangrado activo, con FAST subxifoidea “dudosa”. Se procedió a realizar ventana pericárdica, la cual fue positiva para hemopericardio de 150 ml; se evacuaron los coágulos del saco pericárdico, se introdujo sonda Nelaton 10 Fr para lavado con solución salina 500 ml, hasta obtener retorno de líquido claro. Frente al cese del sangrado y estabilidad del paciente se decidió optar por un manejo conservador, sin toracotomía.
Conclusiones. No todos los casos de hemopericardio traumático por herida por arma cortopunzante requieren toracotomía. El manejo conservador con ventana pericárdica, drenaje de hemopericardio más lavado y dren es una opción en aquellos pacientes que se encuentran estables hemodinámicamente y no se evidencia sangrado activo posterior al drenaje del hemopericardio.
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González-Hadad A, Ordoñez CA, Parra MW, Caicedo Y, Padilla N, Millán M, García A, Vidal-Carpio JM, Pino LF, Herrera MA, Quintero L, Hernández F, Flórez G, Rodríguez-Holguín F, Salcedo A, Serna JJ, Franco MJ, Ferrada R, Navsaria PH. Damage control in penetrating cardiac trauma. Colomb Med (Cali) 2021; 52:e4034519. [PMID: 34188321 PMCID: PMC8216058 DOI: 10.25100/cm.v52i2.4519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/20/2020] [Accepted: 03/18/2021] [Indexed: 11/15/2022] Open
Abstract
Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.
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Affiliation(s)
- Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Carlos A Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - Yaset Caicedo
- Fundacion Valle del Lili, Centro de Investigaciones Clinicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundacion Valle del Lili, Centro de Investigaciones Clinicas (CIC), Cali, Colombia
| | - Mauricio Millán
- Universidad Icesi, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia
| | - Alberto García
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Jenny Marcela Vidal-Carpio
- Hospital General Teofilo Davila, Servicio de Emergencias, Cuenca, Ecuador
- Universidad de Cuenca, Department of Surgery, Cuenca, Ecuador
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Laureano Quintero
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Fabian Hernández
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Guillermo Flórez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Alexander Salcedo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - José Julián Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - María Josefa Franco
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Ricardo Ferrada
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Pradeep H Navsaria
- University of Cape Town, Faculty of Health Sciences, Groote Schuur Hospital, Trauma Center, Anzio Road, Observatory, Cape Town, South Africa
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Manzano-Nunez R, Gomez A, Espitia D, Sierra-Ruiz M, Gonzalez J, Rodriguez-Narvaez JG, Castillo AC, Gonzalez A, Orjuela J, Orozco-Martin V, Bernal F, Giron F, Rios AC, Carranza P, Gonzalez-Hadad A, García-Perdomo HA, García AF. A meta-analysis of the diagnostic accuracy of chest ultrasound for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. J Trauma Acute Care Surg 2021; 90:388-395. [PMID: 33502150 DOI: 10.1097/ta.0000000000003006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND We performed a systematic review (SR) and meta-analysis (MA) to determine the diagnostic accuracy of chest ultrasound (US) compared with a pericardial window (PW) for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. METHODS A literature search in five databases identified relevant articles for inclusion in this SR and MA. Studies were eligible if they evaluated the diagnostic accuracy of chest US, compared with a PW, for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients presenting with penetrating thoracic trauma. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test accuracy within the bivariate mixed-effects logistic regression modeling framework. RESULTS We included five studies in our SR and MA. These studies included a total of 556 trauma patients. The MA found that, compared with PW, the US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients. The presence of a concomitant left hemothorax was frequent in patients with false-negative results. CONCLUSION This SR and MA found that, compared with PW, US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. Caution interpretation of pericardial US results is suggested in the presence of left hemothorax. In these cases, a second diagnostic test should be performed. LEVEL OF EVIDENCE Systematic Review and Meta-analysis, level II.
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Affiliation(s)
- Ramiro Manzano-Nunez
- From the Méderi Hospital Universitario Mayor (R.M.-N., D.E., J.G., J.G.R.-N., A.C.C., A.G., J.O., V.O.-M., F.B., F.G.); Escuela de Medicina y Ciencias de la Salud (R.M.-N., D.E., J.G., J.G.R.-N., A.C.C., A.G., J.O., V.O.-M., F.B., F.G.), Universidad del Rosario, Bogotá, DC; Fundacion Valle del Lili, Clinical Research Center (A.G., M.S.-R.), Cali; Hospital Occidente de Kennedy (A.C.R., P.C.), Bogotá, DC; Sección de Urología, Departamento de Cirugía, (A.G.-H., H.A.G.-P.), Universidad del Valle; and Department of Surgery (A.F.G.), Fundación Valle del Lili, Cali, Colombia
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Maia ADS, Cunha ABD, Pereira MAS, Chaves NP, Morais RSD, Almeida LAD. Late Cardiac Tamponade in a Patient Victim of Penetrating Trauma - Case Report. Braz J Cardiovasc Surg 2020; 35:1017-1019. [PMID: 33306330 PMCID: PMC7731853 DOI: 10.21470/1678-9741-2019-0130] [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] [Indexed: 11/04/2022] Open
Abstract
CASE PRESENTATION A case of a 49-year-old patient, male, victim of stab wound, developing belatedly cardiac tamponade and hemodynamic stability was reported. The patient underwent a pericardial window with drainage of pericardial effusion of blackened aspect; however, without visualization of the cardiac lesion, enlargement of the incision by median sternotomy was opted for. A hematoma was spotted at the left ventricle with epicardial lesion and a patch of pericardium was made with 3-0 polypropylene. The patient developed acute pulmonary edema and atrial fibrillation, which improved after the intensive care unit clinical management, with hospital discharge in the 7th postoperative day.
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