Blunt cardiac rupture. The Emanuel Trauma Center experience.

OBJECTIVE

To analyze the factors affecting outcome in patients with blunt cardiac rupture, including anatomical cardiac injury, associated injury, clinical presentation, age, mechanism of injury, diagnostic method, surgical intervention, and presence of vital signs in the field and on arrival.

DESIGN

Retrospective review.

SETTING

A community-based level I trauma center.

PATIENTS

A consecutive series of 27 patients seen between 1984 and 1993.

MAIN OUTCOME MEASURE

Survival with return to preinjury activity.

RESULTS

Eleven patients (41%) survived resuscitation, surgery, and initial hospital care. Survivors had a lower mean Injury Severity Score (38) than nonsurvivors (62) (P < .05). Three (33%) of nine patients who arrived with no blood pressure or viable electrical heart rhythm survived. No patient survived rupture of two cardiac chambers.

CONCLUSIONS

Patients with blunt cardiac rupture who present with cardiac arrest can survive. Nonsurvivors tend to have more associated injuries, as indicated by higher Injury Severity Scores. Our institution's overall survival rate of 41% (11/27) compares favorably with rates at other trauma centers.