Top

World Journal of Surgery

Published in:

01-05-2020 | Heart Contusion | Original Scientific Report

Emergency Surgery for Blunt Cardiac Injury: Experience in 43 Cases

Authors: Jin-Mou Gao, Ding-Yuan Du, Ling-Wen Kong, Jun Yang, Hui Li, Gong-Bin Wei, Chang-Hua Li, Chao-Pu Liu

Published in: World Journal of Surgery | Issue 5/2020

Abstract

Background

Blunt cardiac injury (BCI) increases with traffic accidents and is an important cause of death in trauma patients. In particular, for patients who need surgical treatment, the mortality rate is extremely high unless the patient is promptly operated on. This study aimed to explore early recognition and expeditious surgical intervention to increase survival.

Methods

All patients with BCIs during the past 15 years were reviewed, and those who underwent operative treatment were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome.

Results

A total of 348 patients with BCIs accounted for 18.3% of 1903 patients with blunt thoracic injury (BTI). Of 348 patients, 43 underwent operative treatment. The main cause of injury was traffic accidents, with an incidence of 48.8%. Of them, steering wheel injuries occurred in 15 patients. In 26 patients, a preoperative diagnosis was obtained by echocardiography, CT scanning, etc. In the remaining 17, who had to undergo urgent thoracotomy without any preoperative imaging, a definitive diagnosis of BCI was proven during the operation. The volume of preoperative infusion or crystalloid was <1000 ml in 31 cases. Preoperative pericardiocentesis was not used in anyone. In 12 patients, the operation commenced within 1 h. Overall mortality was 32.6%. The death was caused by BCI in 9.

Conclusions

Facing a patient with BTI, a high index of suspicion for BCI must be maintained. To manage those requiring operations, early recognition and expeditious thoracotomy are essential. Preoperatively, limited fluid resuscitation is emphasized. We do not advocate preoperative pericardiocentesis.

Emet M, Akoz A, Aslan S et al (2010) Assessment of cardiac injury in patients with blunt chest trauma. Eur J Trauma Emerg Surg 36:441–447. https://doi.org/10.1007/s00068-010-0005-1 CrossRefPubMed

Skinner DL, Laing GL, Rodseth RN et al (2015) Blunt cardiac injury in critically ill trauma patients: a single centre experience. Injury 46:66–70. https://doi.org/10.1016/j.injury.2014.08.051 CrossRefPubMed

Chai HS, Lee SW, Park JS et al (2018) Cardiac arrest associated with aortic valve regurgitation. Am J Emerg Med 36:345.e1–345.e3. https://doi.org/10.1016/j.ajem.2017.11.040 CrossRef

Belliister SA, Dennis BM, Guillamondegui OD (2017) Blunt and penetrating cardiac trauma. Surg Clin North Am 97:1065–1076. https://doi.org/10.1016/j.suc.2017.06.012 CrossRef

Marcolini EG, Keegan J (2015) Blunt cardiac injury. Emerg Med Clin North Am 33:519–527. https://doi.org/10.1016/j.emc.2015.04.003 CrossRefPubMed

Yousef R, Carr JA (2014) Blunt cardiac trauma: a review of the current knowledge and management. Ann Thorac Surg 98:1134–1140. https://doi.org/10.1016/j.athoracsur.2014.04.043 CrossRefPubMed

Hammer MM, Raptis DA, Cummings KW et al (2016) Imaging in blunt cardiac injury: computed tomographic findings in cardiac contusion and associated injuries. Injury 47:1025–1030. https://doi.org/10.1016/j.injury.2015.11.008 CrossRefPubMed

Wall MJ, Mattox KL, Wolf DA (2005) The cardiac pendulun: blunt rupture of the pericardium with strangulation of the heart. J Trauma 59:136–142. https://doi.org/10.1097/01.TA.0000171466.47885.C5 CrossRefPubMed

Verma N, White CS, Mohanned TL (2018) Blunt cardiothoracic trauma: common injuries and diagnosis. Semin Roentgenol 53:171–177. https://doi.org/10.1053/j.ro.2018.02.007 CrossRefPubMed

10.

Lindenmann J, Matzi V, Neuboeck N et al (2010) Traumatic pericardial rupture with cardiac herniation. Ann Thorac Surg 89:2028–2030. https://doi.org/10.1016/j.athoracsur.2009.10.048 CrossRefPubMed

11.

Mattox KL, Flint LM, Carrico CJ et al (1992) Blunt cardiac injury. J Trauma 33:649–650CrossRef

12.

Gosavi S, Tyroch AH, Mukherjee D (2016) Cardiac trauma. Angiology 67:896–901. https://doi.org/10.1177/0003319715627954 CrossRefPubMed

13.

Huis in’t Veld MA, Craft CA, Hood RE (2018) Blunt cardiac trauma review. Cardiol Clin 36:183–191. https://doi.org/10.1016/j.ccl.2017.08.010 CrossRef

14.

Raptis DA, Bhalla S, Raptis CA (2019) Computed tomographic imaging of cardiac trauma. Radiol Clin North Am 57:201–212. https://doi.org/10.1016/j.rcl.2018.08.009 CrossRefPubMed

15.

Verma N, Robinson JD, Gunn ML (2018) Pericardial rupture and cardiac herniation in blunt trauma. Radial Case Rep 13:573–575. https://doi.org/10.1016/j.radcr.2018.02.013 CrossRef

16.

Nassiri N, Yu A, Statkus N et al (2009) Imaging of cardiac herniation in traumatic pericardial rupture. J Thorac Imaging 24:69–72. https://doi.org/10.1097/RTI.0b013e31818d12de CrossRefPubMed

17.

Burrell AJ, Kaye DM, Fitzgerald MC et al (2017) Cardiac magnetic resonance imaging in suspected blunt cardiac injury: a prospective, pilot, cohort study. Injury 48:1013–1019. https://doi.org/10.1016/j.injury.2017.02.025 CrossRefPubMed

18.

Gao JM, Gao YH, Wei GB et al (2004) Penetrating cardiac wounds: principles for surgical management. World J Surg 28:1025–1029. https://doi.org/10.1007/s00268-004-7523-0 CrossRefPubMed

19.

Soar J, Perkins GD, Abbas G et al (2010) European Resuscitation Council guidelines for resuscitation 2010: section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 81:1400–1433. https://doi.org/10.1016/j.resuscitation.2010.08.015 CrossRefPubMed

20.

Demetriades D, van der Veen BW (1983) Penetrating injuries of the heart: experience over two years in South Africa. J Trauma 23:1034–1041CrossRef

21.

Mishra B, Gupta A, Sagar S et al (2016) Traumatic cardiac injury: experience from a level-1 trauma centre. Chin J Traumatol 19:333–336. https://doi.org/10.1016/j.cjtee.2016.08.001 CrossRefPubMedPubMedCentral

22.

Doi A, Lee CN, Leng SA et al (2012) Simple and quick repair of cardiac rupture due to blunt chest trauma. Asian Cardiovasc Thorac Ann 20:64–65. https://doi.org/10.1177/0218492311421444 CrossRefPubMed

23.

Pinni S, Kumar V, Dharap SB (2016) Blunt cardiac rupture: a diagnostic challenge. J Clin Diagn Res 10:PD27–PD28. https://doi.org/10.7860/JCDR/2016/22220.8894 CrossRefPubMedPubMedCentral

24.

El-Menyar A, Al Thani H, Zarour A et al (2012) Understanding traumatic blunt cardiac injury. Ann Card Anaesth 15:287–295. https://doi.org/10.4103/0971-9784.101875 CrossRefPubMed

25.

Bock JS, Benitez RM (2012) Blunt cardiac injury. Cardiol Clin 30:545–555. https://doi.org/10.1016/j.ccl.2012.07.001 CrossRefPubMed

Title: Emergency Surgery for Blunt Cardiac Injury: Experience in 43 Cases
Authors: Jin-Mou Gao
Ding-Yuan Du
Ling-Wen Kong
Jun Yang
Hui Li
Gong-Bin Wei
Chang-Hua Li
Chao-Pu Liu
Publication date: 01-05-2020
Publisher: Springer International Publishing
Keywords: Heart Contusion
Echocardiography
Pericardiocentesis
Echocardiography
Thoracotomy
Published in: World Journal of Surgery / Issue 5/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05369-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Emergency Surgery for Blunt Cardiac Injury: Experience in 43 Cases

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2020

Impact of Modified Frozen Elephant Trunk Procedure on Downstream Aorta Remodeling in Acute Aortic Dissection: CT Scan Follow-Up

Incidence of Incisional Hernia Repair After Laparoscopic Compared to Open Resection of Colonic Cancer: A Nationwide Analysis of 17,717 Patients

Correction to: Prognostic Assessment of Non-functioning Neuroendocrine Pancreatic Neoplasms as a Basis for Risk-Adapted Resection Strategies

Meta-analysis of Enhanced Recovery After Surgery (ERAS) Protocols in Emergency Abdominal Surgery

Reducing Gastroschisis Mortality: A Quality Improvement Initiative at a Ugandan Pediatric Surgery Unit

Single Gland, Ectopic Location: Adenomas are Common Causes of Primary Hyperparathyroidism in Children and Adolescents