Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center

Michael J. Mina; Rashi Jhunjhunwala; Rondi B. Gelbard; Stacy D. Dougherty; Jacquelyn S. Carr; Christopher J. Dente; Jeffrey M. Nicholas; Amy D. Wyrzykowski; Jeffrey P. Salomone; Gary A. Vercruysse; David V. Feliciano; Bryan C. Morse

doi:10.1016/j.amjsurg.2016.07.014

Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center

Michael J. Mina, Rashi Jhunjhunwala, Rondi B. Gelbard, Stacy D. Dougherty, Jacquelyn S. Carr, Christopher J. Dente, Jeffrey M. Nicholas, Amy D. Wyrzykowski, Jeffrey P. Salomone, Gary A. Vercruysse, David V. Feliciano, Bryan C. Morse^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

Background Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. Methods From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center. Results Over the 10-year study, 80 PCI patients survived to reach the hospital. Of the 21 factors analyzed, prehospital cardiopulmonary resuscitation (odds ratio [OR] = 30), scene time greater than 10 minutes (OR = 58), resuscitative thoracotomy (OR = 19), and massive left hemothorax (OR = 15) had the greatest impact on mortality. Cardiac tamponade physiology demonstrated a “protective” effect for survivors to the hospital (OR =.08). Conclusions Trauma surgeons can improve mortality after PCI by minimizing time to the operating room for early control of hemorrhage. In PCI patients, tamponade may provide a physiologic advantage (lower mortality) compared to exsanguination.

Original language	English
Pages (from-to)	1109-1115
Number of pages	7
Journal	American Journal of Surgery
Volume	213
Issue number	6
DOIs	https://doi.org/10.1016/j.amjsurg.2016.07.014
State	Published - Jun 2017
Externally published	Yes

Keywords

Cardiac box
Cardiac injury
ED thoracotomy
Penetrating cardiac injury
Penetrating cardiac wound
Tamponade

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10.1016/j.amjsurg.2016.07.014

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Mina, M. J., Jhunjhunwala, R., Gelbard, R. B., Dougherty, S. D., Carr, J. S., Dente, C. J., Nicholas, J. M., Wyrzykowski, A. D., Salomone, J. P., Vercruysse, G. A., Feliciano, D. V., & Morse, B. C. (2017). Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center. American Journal of Surgery, 213(6), 1109-1115. https://doi.org/10.1016/j.amjsurg.2016.07.014

@article{8e38e04538a74932bb7affd8d7380764,

title = "Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center",

abstract = "Background Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. Methods From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center. Results Over the 10-year study, 80 PCI patients survived to reach the hospital. Of the 21 factors analyzed, prehospital cardiopulmonary resuscitation (odds ratio [OR] = 30), scene time greater than 10 minutes (OR = 58), resuscitative thoracotomy (OR = 19), and massive left hemothorax (OR = 15) had the greatest impact on mortality. Cardiac tamponade physiology demonstrated a “protective” effect for survivors to the hospital (OR =.08). Conclusions Trauma surgeons can improve mortality after PCI by minimizing time to the operating room for early control of hemorrhage. In PCI patients, tamponade may provide a physiologic advantage (lower mortality) compared to exsanguination.",

keywords = "Cardiac box, Cardiac injury, ED thoracotomy, Penetrating cardiac injury, Penetrating cardiac wound, Tamponade",

author = "Mina, {Michael J.} and Rashi Jhunjhunwala and Gelbard, {Rondi B.} and Dougherty, {Stacy D.} and Carr, {Jacquelyn S.} and Dente, {Christopher J.} and Nicholas, {Jeffrey M.} and Wyrzykowski, {Amy D.} and Salomone, {Jeffrey P.} and Vercruysse, {Gary A.} and Feliciano, {David V.} and Morse, {Bryan C.}",

note = "Publisher Copyright: {\textcopyright} 2016 Elsevier Inc.",

year = "2017",

month = jun,

doi = "10.1016/j.amjsurg.2016.07.014",

language = "English",

volume = "213",

pages = "1109--1115",

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Mina, MJ, Jhunjhunwala, R, Gelbard, RB, Dougherty, SD, Carr, JS, Dente, CJ, Nicholas, JM, Wyrzykowski, AD, Salomone, JP, Vercruysse, GA, Feliciano, DV & Morse, BC 2017, 'Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center', American Journal of Surgery, vol. 213, no. 6, pp. 1109-1115. https://doi.org/10.1016/j.amjsurg.2016.07.014

TY - JOUR

T1 - Factors affecting mortality after penetrating cardiac injuries

T2 - 10-year experience at urban level I trauma center

AU - Mina, Michael J.

AU - Jhunjhunwala, Rashi

AU - Gelbard, Rondi B.

AU - Dougherty, Stacy D.

AU - Carr, Jacquelyn S.

AU - Dente, Christopher J.

AU - Nicholas, Jeffrey M.

AU - Wyrzykowski, Amy D.

AU - Salomone, Jeffrey P.

AU - Vercruysse, Gary A.

AU - Feliciano, David V.

AU - Morse, Bryan C.

PY - 2017/6

Y1 - 2017/6

N2 - Background Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. Methods From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center. Results Over the 10-year study, 80 PCI patients survived to reach the hospital. Of the 21 factors analyzed, prehospital cardiopulmonary resuscitation (odds ratio [OR] = 30), scene time greater than 10 minutes (OR = 58), resuscitative thoracotomy (OR = 19), and massive left hemothorax (OR = 15) had the greatest impact on mortality. Cardiac tamponade physiology demonstrated a “protective” effect for survivors to the hospital (OR =.08). Conclusions Trauma surgeons can improve mortality after PCI by minimizing time to the operating room for early control of hemorrhage. In PCI patients, tamponade may provide a physiologic advantage (lower mortality) compared to exsanguination.

AB - Background Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. Methods From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center. Results Over the 10-year study, 80 PCI patients survived to reach the hospital. Of the 21 factors analyzed, prehospital cardiopulmonary resuscitation (odds ratio [OR] = 30), scene time greater than 10 minutes (OR = 58), resuscitative thoracotomy (OR = 19), and massive left hemothorax (OR = 15) had the greatest impact on mortality. Cardiac tamponade physiology demonstrated a “protective” effect for survivors to the hospital (OR =.08). Conclusions Trauma surgeons can improve mortality after PCI by minimizing time to the operating room for early control of hemorrhage. In PCI patients, tamponade may provide a physiologic advantage (lower mortality) compared to exsanguination.

KW - Cardiac box

KW - Cardiac injury

KW - ED thoracotomy

KW - Penetrating cardiac injury

KW - Penetrating cardiac wound

KW - Tamponade

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EP - 1115

JO - American Journal of Surgery

JF - American Journal of Surgery

IS - 6

ER -

Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center

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Keywords

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