Strategies in the management of penetrating cardiac trauma based on 14 surviving patients from a strife-ridden area

Background: Penetrating cardiac injury is one of the most life-threatening conditions. Most patients die before reaching the hospital and those that arrive alive must receive immediate surgical intervention based on a high index of suspicion. Methods: A retrospective study was conducted of 14 patients with penetrating cardiac trauma who were surgically treated, eight who underwent surgery in Israel and six who underwent surgery in Gaza, The Palestinian National Authority. The factors influencing survival, morbidity and mortality were evaluated and long term follow-up, clinical and demographic data were examined. Results: Fourteen patients underwent urgent surgery due to penetrating heart injury. Twelve patients were in shock on admission, at exploration 11 out of the 14 patients were found to be suffering from cardiac tamponade, eight patients out of the 14 were treated by chest tubes preoperatively due to a hemothorax and seven of these eight patients were also found to have a cardiac tamponade at exploration. None of the 14 patients suffered damage to the coronary arteries. In all patients, bleeding from the hole in the heart was controlled by digital pressure and then closed using Vicryl pledgeted polypropylene sutures. There were no cases of mortality or late morbidity in any of the patients. Conclusions: Cardiac tamponade and the absence of coronary vessel injury enabled successful early definitive management of penetrating cardiac trauma patients. Transferring the patient to the operating room without delay is the key to survival.