Asensio et al evaluated patients with penetrating injuries to the heart from gunshots or stab wounds. They identified factors which correlated with survival. The authors are from the University of Southern California in Los Angeles.
Factors affecting survival:
(1) cardiovascular-respiratory score (CVRS), a subset of the Trauma Score, which summarizes a number of physiologic findings
(2) Organ Injury Scale (OIS)
(3) mechanism of injury
(4) cardiopulmonary arrest
(5) location of thoracotomy
(6) initial rhythm upon opening the pericardium
(7) exsanguination
(8) need for aortic cross-clamping during surgery
(9) inability to restore an organized rhythm after thoracotomy
(10) inability to restore blood pressure after thoracotomy
|
Parameter |
Finding |
Mortality |
|
Cardiovascular-Respiratory Score (CVRS) |
0 to 3 |
28% |
|
|
4 to 11 |
88.5% |
|
Organ Injury Scale (OIS) |
Grade IV |
52% |
|
|
Grade V |
75% |
|
|
Grade VI |
100% |
|
mechanism of injury |
stab wound |
32% |
|
|
gunshot wound |
85.7% |
|
cardiopulmonary arrest |
no |
31.6% |
|
|
yes |
78% |
|
location of thoracotomy |
Emergency Department |
83.8% |
|
|
operating room |
30.4% |
|
normal sinus rhythm |
yes |
32% |
|
|
no |
85.7% |
|
exsanguination |
absent |
33.3% |
|
|
present |
90.6% |
|
aortic clamping during surgery |
no |
29.6% |
|
|
yes |
90.6% |
|
organized rhythm restored after surgery |
no |
100% |
|
|
yes |
33.3% |
|
measurable blood pressure restored after surgery |
no |
96.6% |
|
|
yes |
32.3% |
where:
• Cardiopulmonary arrest in the field had a much higher mortality rate (100%).
• Direct injury to a coronary artery was rare but associated with a high mortality.
• The time at the scene and time for transport to the hospital can affect outcome.
Factors not found to predict outcome:
(1) pericardial tamponade
(2) active bleeding from the heart (unless exsanguinating)
(3) injury to a specific chamber
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Cardiology
ICD-10: ,
