Selective Use of Pericardial Window and Drainage as Sole Treatment for Hemopericardium from Penetrating Chest Trauma

Authors

Paul J. Chestovich MD, University of Nevada, Las VegasFollow
Christopher F. McNicoll, University of Nevada, Las VegasFollow
Douglas R. Fraser, University of Nevada, Las VegasFollow
Purvi P. Patel, University of Nevada, Las Vegas
Deborah A. Kuhls, University of Nevada, Las VegasFollow
Esmeralda Clark, University of Nevada, Las Vegas
John J. Fildes, University of Nevada, Las VegasFollow

Document Type

Article

Publication Date

6-25-2018

Publication Title

Trauma Surgery and Acute Care Open

Volume

3

Issue

1

First page number:

1

Last page number:

6

Abstract

Background

Penetrating cardiac injuries (PCIs) are highly lethal, and a sternotomy is considered mandatory for suspected PCI. Recent literature suggests pericardial window (PCW) may be sufficient for superficial cardiac injuries to drain hemopericardium and assess for continued bleeding and instability. This study objective is to review patients with PCI managed with sternotomy and PCW and compare outcomes.

Methods

All patients with penetrating chest trauma from 2000 to 2016 requiring PCW or sternotomy were reviewed. Data were collected for patients who had PCW for hemopericardium managed with only pericardial drain, or underwent sternotomy for cardiac injuries grade 1–3 according to the American Association for the Surgery of Trauma (AAST) Cardiac Organ Injury Scale (OIS). The PCW+drain group was compared with the Sternotomy group using Fisher’s exact and Wilcoxon rank-sum test with P<0.05 considered statistically significant.

Results

Sternotomy was performed in 57 patients for suspected PCI, including 7 with AAST OIS grade 1–3 injuries (Sternotomy group). Four patients had pericardial injuries, three had partial thickness cardiac injuries, two of which were suture-repaired. Average blood drained was 285mL (100–500 mL). PCW was performed in 37 patients, and 21 had hemopericardium; 16 patients proceeded to sternotomy and 5 were treated with pericardial drainage (PCW+drain group). All PCW+drain patients had suction evacuation of hemopericardium, pericardial lavage, and verified bleeding cessation, followed by pericardial drain placement and admission to intensive care unit (ICU). Average blood drained was 240mL (40–600 mL), and pericardial drains were removed on postoperative day 3.6 (2–5). There was no significant difference in demographics, injury mechanism, Revised Trauma Score exploratory laparotomies, hospital or ICU length of stay, or ventilator days. No in-hospital mortality occurred in either group.

Conclusions

Hemodynamically stable patients with penetrating chest trauma and hemopericardium may be safely managed with PCW, lavage and drainage with documented cessation of bleeding, and postoperative ICU monitoring.

Level of evidence

Therapeutic study, level IV.

Disciplines

Medicine and Health Sciences | Surgical Procedures, Operative

File Format

PDF

File Size

347 Kb

Language

English

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Repository Citation

Chestovich, P. J., McNicoll, C. F., Fraser, D. R., Patel, P. P., Kuhls, D. A., Clark, E., Fildes, J. J. (2018). Selective Use of Pericardial Window and Drainage as Sole Treatment for Hemopericardium from Penetrating Chest Trauma. Trauma Surgery and Acute Care Open, 3(1), 1-6.
http://dx.doi.org/10.1136/tsaco-2018-000187