Cardiac and Major Vascular Injuries After Chest Trauma: 5 Years of Experience

Year 2024, Volume: 15 Issue: 53, 123 - 129, 05.12.2024

İbrahim Demir , Doğan Yetüt , Sinan Ömeroğlu

https://doi.org/10.17944/interdiscip.1479597

Abstract

Background: We aimed to determine the incidence, clinical presentation, diagnostic approaches and effective surgical treatment of penetrating thoracic injuries involving the heart and major vessels.
Material and Methods: 126 patients, who had chest trauma between January 2015 and January 2019 were evaluated. The relationship between findings at the time of admission and postoperative patient status was attempted to be revealed.
Results: The mean age of patients included in this study was 27 ± 6.1 years. The stab injury was the most common mechanism of injury (n=76, 60.3%).The most commonly injured organ was found to be the heart with 56 patients (44.4%).The preoperative mean arterial pressure of patients transferred to the intensive care without mechanical support was 82 mmHg (range: 0–135 mmHg), while it was at 65 mmHg (range: 0–112 mmHg) for patients who died during the operation (p < 0.001).The hemoglobin values of patients who lived and died at admission were 6.9 mg/dl (range: 4.1–11 mg/dl) and 5.6 mg/dl (range: 2.8–10.1 mg/dl), respectively (p<0.001).
Conclusion: It is possible to predict mortality by evaluating complete blood count, systolic blood pressure, and site of injury at admission. Success can be achieved with accurate diagnosis, resuscitation, and early surgical interventions.

Keywords

Cardiac injury, Chest Trauma, Vascular injury, Thorax penetration

References

• Fitzgerald MC, Yong MS, Martin K, Zimmet A, Marasco SF, Mathew J, et al. Emergency department resuscitative thoracotomy at an adult major trauma centre: Outcomes following a training programme with standardised indications. Emerg Med Australas 2020;32(4):657-62. https://doi.org/10.1111/1742-6723.13530
• Dogrul BN, Kiliccalan I, Asci ES, Peker SC.Blunt trauma related chest wall and pulmonary injuries: An overview. Chin J Traumatol. 2020;23(3):125-38. https://doi.org/10.1016/j.cjtee.2020.04.00
• Gao JM, Du DY, Kong LW, Yang J, Li H, Wei GB, Li CH, Liu CP. Emergency Surgery for Blunt Cardiac Injury: Experience in 43 Cases. World J Surg 2020;44(5):1666-72. https://doi.org/10.1007/s00268-020-05369-6
• Dereli Y, Ozdemir R, Ağrış M, Oncel M, Hoşgör K, Ozdiş AS. Penetran kardiyak yaralanmalar: 21 olgunun değerlendirilmesi [Penetrating cardiac injuries: assessment of 21 patients]. Ulus Travma Acil Cerrahi Derg 2012;18(5):441-45. https://doi.org/10.5505/tjtes.2012.93467
• Nan YY, Lu MS, Liu KS, Huang YK, Tsai FC, Chu JJ, Lin PJ. Blunt traumatic cardiac rupture: therapeutic options and outcomes. Injury. 2009;40(9):938-45. https://doi.org/10.1016/j.injury.2009.05.016.
• Demirhan R, Onan B, Oz K, Halezeroglu S. Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience. Interact Cardiovasc Thorac Surg 2009;9(3):450-53. https://doi.org/10.1510/icvts.2009.206599
• Onan B, Demirhan R, Öz K, Onan IS. Cardiac and great vessel injuries after chest trauma: our 10-year experience. Ulus Travma Acil Cerrahi Derg. 2011;17(5):423-29.
• Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open 2017;2(1):e000064. https://doi.org/10.1136/tsaco-2016-000064
• Göz M, Cakir O, Eren MN. Penetran kalp yaralanmalari; mortalite belirleyicilerinin analizi [Penetrating cardiac injuries: analysis of the mortality predictors]. Ulus Travma Acil Cerrahi Dergisi. 2009;15(4):362-66.
• Orlas CP, Herrera-Escobar JP, Zogg CK, Serna JJ, Meléndez JJ, Gómez A, et al. Chest Trauma Outcomes: Public Versus Private Level I Trauma Centers. World J Surg 2020;44(6):1824-34. https://doi.org/10.1007/s00268-020-05400-w
• Yoon B, Grasso S, Hofmann LJ. Management of Bullet Emboli to the Heart and Great Vessels. Mil Med. 2018;183(9-10):e307-e313. https://doi.org/10.1093/milmed/usx191
• Kang N, Hsee L, Rizoli S, Alison P. Penetrating cardiac injury: overcoming the limits set by Nature. Injury 2009;40(9):919-27. https://doi.org/10.1016/j.injury.2008.12.008
• Beyaz MO, Öztaş DM, Uğurlucan M. İzole Penetran Kardiyak Yaralanmalarda Güncel Tedavi Yaklaşımları. Medical Journal of Mugla Sitki Kocman University 2022;9(1):49-52. doi:10.47572/muskutd.856757
• Ceviker K, Tulay C, Sahinalp S, Atlı HF. Factors affecting mortality in cardiac injury of penetrating thorax trauma: a retrospective study. Gaziantep Med J 2014);20(1):35-41. https://doi.org/10.5455/GMJ-30-44548
• Ecevit, A, Altıntaş, G, Ciçek, O. F, Uzun, A, Kadiroğulları, E, & Bardakçı, H. Travel of the shot. Ann Thor Surg 2013;95(5):1804. https://doi.org/10.1016/j.athoracsur.2012.09.016.
• Fatimi SH, Hanif HM, Awais A, Shamsi G, Muzaffar M. Major thoracic vessels and cardiac trauma: case series from a center in a developing country. Ulus Travma Acil Cerrahi Derg 2012;18(6):490-94. https://doi.org/10.5505/tjtes.2012.39225
• Soong TK, Wee IJY, Tseng FS, Syn N, Choong AMTL. A systematic review and meta-regression analysis of nonoperative management of blunt traumatic thoracic aortic injury in 2897 patients. J Vasc Surg 2019;70(3):941-53.e13. https://doi.org/ 10.1016/j.jvs.2018.12.045.
• Campbell NC, Thomson SR, Muckart DJ, Meumann CM, Van Middelkoop I, Botha JB. Review of 1198 cases of penetrating cardiac trauma. Br J Surg 1997;84(12):1737-40.
• Ahmad R, Bhatti DS, Bokhari MHT, Asad A. A University Hospital Based Study on Thoracic Trauma: Life Threatening Event, Its Etiology, Presentation, and Management. Cureus 2019;11(12):e6306. https://doi.org/10.7759/cureus.6306
• Onat S, Ulku R, Avci A, Ates G, Ozcelik C. Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center. Injury 2011;42(9):900-4 https://doi.org/10.1016/j.injury.2010.02.004
• Chen CY, Hsu TY, Chen WK, Muo C H, Chen HC, Shih HM. The use of extracorporeal membrane oxygenation in trauma patients: a national case-control study. Medicine(Baltimore) 2018;97(36):e12223. https://doi.org/10.1097/md.0000000000012223.e12223
• Refaely Y, Koyfman L, Friger M, Ruderman L, Abu Saleh M, Klein M, et al. Predictors of survival after emergency department thoracotomy in trauma patients with predominant thoracic injuries in Southern Israel: a retrospective survey. Open Access Emerg Med 2019;11:95-101. https://doi.org/10.2147/OAEM.S192358
• Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 2011;365(20):1905-14. https://doi.org/10.1056/NEJMct1103720
• Chang CH, Chen HC, Caffrey JL, Hsu J, Lin JW, Lai MS, Chen YS. Survival Analysis After Extracorporeal Membrane Oxygenation in Critically Ill Adults: A Nationwide Cohort Study Circulation 2016;133(24):2423-33. https://doi.org/10.1161/CIRCURCULATIONAHA.115.019143
• Foroulis CN, Kleontas A, Karatzopoulos A, Nana C, Tagarakis G, Tossios P, Zarogoulidis P, Anastasiadis K. Early reoperation performed for the management of complications in patients undergoing general thoracic surgical procedures. J Thorac Dis. 2014;6(1):21-31. https://doi.org/10.3978/j.issn.2072-1439.2014.02.22.