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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 10/2023

03-04-2023 | Sternotomy | Original Article

The role and timing of cardiopulmonary bypass in the surgical repair of traumatic cardiac injury

Authors: Mayo Kondo, Shinichi Ijuin, Tomonori Haraguchi, So Izumi, Reiko Kanno, Kazunori Sakaguchi, Kazumasa Edono, Haruki Nakayama, Satoshi Ishihara, Takuro Tsukube

Published in: General Thoracic and Cardiovascular Surgery | Issue 10/2023

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Abstract

Objectives

The management of traumatic cardiac injury (TCI) may require a prompt treatment, including the use of cardiopulmonary bypass (CPB) followed by surgical repair. This study evaluated the surgical outcomes among TCI patients.

Methods

From August 2003, 21 patients with TCI were underwent emergent surgical repair. TCI was classified as grade I to VI according to the Cardiac Injury Organ Scale (CIS) of the American Association for Surgery of Trauma, and severity was evaluated using the Injury Severity Score (ISS).

Results

Of the 21 patients, the mean age and ISS were 54.8 ± 18.8 years and 26.5 ± 6.3, respectively, including13 blunt and eight penetrating injuries. A CIS grade of IV or greater was observed in 17 patients and unstable hemodynamics in 16. CPB or extracorporeal membranous oxygenation (ECMO) were used in three patients before they underwent surgery and in seven patients after undergoing sternotomy, including three on whom a canular access route was prepared preoperatively. There was a significant correlation between the preoperative width of pericardial effusion and the use of CPB (p < 0.05). Overall hospital mortality was 14.3%, and 100% in patients with uncontrolled bleeding during surgery. All patients who underwent CPB before or during surgery, in whom a standby canular access route had been established, survived.

Conclusions

TCI is associated with a high mortality rate, and survival depends on efficient diagnosis and the rapid mobilization of the operating room. Preparations for CPB or establishing a canular access route should be made before surgical procedures in cases in which the hemodynamics are unstable.
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Metadata
Title
The role and timing of cardiopulmonary bypass in the surgical repair of traumatic cardiac injury
Authors
Mayo Kondo
Shinichi Ijuin
Tomonori Haraguchi
So Izumi
Reiko Kanno
Kazunori Sakaguchi
Kazumasa Edono
Haruki Nakayama
Satoshi Ishihara
Takuro Tsukube
Publication date
03-04-2023
Publisher
Springer Nature Singapore
Published in
General Thoracic and Cardiovascular Surgery / Issue 10/2023
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-023-01931-w

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