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

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] 5 30), scene time greater than 10 minutes (OR 5 58), resuscitative thoracotomy (OR 5 19), and massive left hemothorax (OR 5 15) had the greatest impact on mortality. Cardiac tamponade physiology demonstrated a "protective'' effect for survivors to the hospital (OR 5.08). 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. (C) 2016 Elsevier Inc. All rights reserved.