@article{ref1,
title="Penetrating cardiac trauma: management strategy based on 129 surgical emergencies over 2 years",
journal="Annals of thoracic surgery",
year="1992",
author="Knott-Craig, C. J. and Dalton, R. P. and Rossouw, G. J. and Barnard, P. M.",
volume="53",
number="6",
pages="1006-1009",
abstract="Between 1986 and 1988, 129 patients with stab wounds to the heart were referred from the emergency room of our institution for a thoracic surgical procedure. Multiple entrance wounds of the heart were present in 12 patients, and through-and-through stab wounds were encountered in another 10. The overall hospital mortality rate was 8.5% (11/129), which includes a 54% mortality rate for the 13 patients undergoing emergency room thoracotomy. These patients were pulseless and unconscious either on arrival (n = 8) or soon thereafter (n = 5). Cardiopulmonary bypass was not used during the primary operation, although 7 patients underwent subsequent intracardiac repair with bypass without hospital mortality. Important aspects of our preoperative management strategy include: (1) aggressive transfusion to improve the central venous pressure/intrapericardial pressure gradient; (2) rapid drainage of the pleural and pericardial spaces to reduce intrapericardial pressure; (3) empirical partial correction of metabolic acidosis with sodium bicarbonate; and (4) emergency operation without unnecessary cardiac imaging. Patients suspected of having penetrating cardiac trauma and cardiac tamponade are best managed by aggressive primary intervention and immediate operation.<p /> <p>Language: en</p>",
language="en",
issn="0003-4975",
doi="",
url="http://dx.doi.org/"
}