Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital & Hyogo Emergency Medical Center, 1-3-1 Wakihama-Kaigandori Chuo-Ku, Kobe, 651-0073, Japan.
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan.
Gen Thorac Cardiovasc Surg. 2023 Oct;71(10):561-569. doi: 10.1007/s11748-023-01931-w. Epub 2023 Apr 3.
The management of traumatic cardiac injury (TCI) may require a prompt treatment, including the use of cardiopulmonary bypass (CPB) followed by surgical repair. This study evaluated the surgical outcomes among TCI patients.
From August 2003, 21 patients with TCI were underwent emergent surgical repair. TCI was classified as grade I to VI according to the Cardiac Injury Organ Scale (CIS) of the American Association for Surgery of Trauma, and severity was evaluated using the Injury Severity Score (ISS).
Of the 21 patients, the mean age and ISS were 54.8 ± 18.8 years and 26.5 ± 6.3, respectively, including13 blunt and eight penetrating injuries. A CIS grade of IV or greater was observed in 17 patients and unstable hemodynamics in 16. CPB or extracorporeal membranous oxygenation (ECMO) were used in three patients before they underwent surgery and in seven patients after undergoing sternotomy, including three on whom a canular access route was prepared preoperatively. There was a significant correlation between the preoperative width of pericardial effusion and the use of CPB (p < 0.05). Overall hospital mortality was 14.3%, and 100% in patients with uncontrolled bleeding during surgery. All patients who underwent CPB before or during surgery, in whom a standby canular access route had been established, survived.
TCI is associated with a high mortality rate, and survival depends on efficient diagnosis and the rapid mobilization of the operating room. Preparations for CPB or establishing a canular access route should be made before surgical procedures in cases in which the hemodynamics are unstable.
创伤性心脏损伤（TCI）的治疗可能需要迅速进行，包括使用体外循环（CPB），随后进行手术修复。本研究评估了 TCI 患者的手术结果。
自 2003 年 8 月以来，21 例 TCI 患者接受了紧急手术修复。TCI 根据美国创伤外科学会的心脏损伤器官评分（CIS）分为 I 至 VI 级，并使用损伤严重程度评分（ISS）进行严重程度评估。
21 例患者的平均年龄和 ISS 分别为 54.8±18.8 岁和 26.5±6.3，包括 13 例钝性和 8 例穿透性损伤。17 例患者 CIS 分级为 IV 级或更高级别，16 例患者存在不稳定的血流动力学。3 例患者在手术前和 7 例患者在胸骨切开术后使用 CPB 或体外膜肺氧合（ECMO），其中 3 例患者在术前准备了管腔接入途径。术前心包积液的宽度与 CPB 的使用呈显著相关（p<0.05）。总住院死亡率为 14.3%，手术中无法控制出血的患者死亡率为 100%。所有在手术前或手术中使用 CPB 的患者，其中建立了备用管腔接入途径，均存活。
TCI 死亡率较高，存活取决于有效的诊断和手术室的快速调动。在血流动力学不稳定的情况下，应在手术前准备 CPB 或建立管腔接入途径。
