Case report: penetrating cardiac injury secondary to a terrorism-related nail bomb explosion

Fatal cardiac tamponade by Bodkin

Cardiac tamponade is life-threatening, slow or rapid compression of the heart due to the pericardial accumulation of fluid, pus, blood, clots or gas, as a result of effusion, trauma or rupture of the heart. Penetrating injuries of the chest are most commonly the result of stab wounds and are often associated with a range of potentially life-threatening injuries. It must be treated by pericardial drainage as soon as possible. Sometimes the injury resulting in life-threatening conditions may be so small that it could be missed in the first instance. We present a case report in which the deceased was stabbed by Bodkin at road side. As the wound was so minute, it was not appreciated and time was lost in getting treatment, resulting in loss of a precious life.

Blind subxiphoid pericardiotomy to relieve critical acute hemopericardium: a final report

PURPOSE

Percutaneous catheter drainage (PCD) has been considered a standard method of relieving acute cardiac tamponade. Although conventional subxiphoid pericardiotomy is useful even for clotted hemopericardium, it has been believed to be unsuitable for emergency treatment because it is a time-consuming procedure. We report our modified pericardiotomy technique that can be used for emergency management.

METHODS

We designed a prospective observational study to evaluate blind subxiphoid pericardiotomy (BSP) for critical cardiac tamponade due to hemopericardium. Emergency patients (n = 148) with acute hemopericardium secondary to trauma (n = 12), acute aortic disease (n = 122), or cardiac rupture following acute myocardial infarction (n = 14) were the subjects. Early results were compared between the BSP group (n = 53) and the PCD group (n = 95).

RESULTS

BSP was effective at relieving cardiac tamponade in all 53 cases, but PCD was ineffective in 12 cases (12.6 %, p = 0.008). Procedure-related complication rates of BSP and PCD were 0 and 16.8 %, respectively (p = 0.002). Survival rates for the BSP and PCD groups were 18.9 and 6.3 %, respectively (p = 0.018). Since 2005, when we discarded the restriction that only board-certified surgeons should perform BSP, acute care physicians (including trainees) have performed BSP for 22 patients without procedure-related complications.

CONCLUSIONS

BSP was safe and effective for cardiac tamponade due to acute hemopericardium. Critical complications during PCD for hemopericardium could not be avoided in some cases because of clots in the pericardium.

Emergent cardiopulmonary bypass in canines with penetrating cardiac wounds caused by gunshot

BACKGROUND

Most patients with penetrating cardiac wounds die within minutes of injury from uncontrolled haemorrhage and acute cardiac dysfunction. Thus, sustaining sufficient circulation rapidly is crucial to saving lives. Emergent cardiopulmonary bypass (CPB) is a potential intervention to maintain circulation after penetrating cardiac wounds from a gunshot.

METHODS

Canines were wounded with a bullet and randomly split into one of three treatment groups. Animals in group 1 (Gp1) were treated with conventional methods. Animals in group 2 (Gp2) received emergent CPB for 180 min and autologous blood transfusion. Animals in group 3 (Gp3) received emergent CPB for 30 min followed by surgical repair. Animal survival, haemodynamics and blood chemistry were measured, and lung water content was evaluated at the end of the experiment.

RESULTS

The right ventricle was the most severely wounded cardiac chamber. In Gp1, mean arterial pressure and central venous pressure were dramatically decreased 8 min after injury, and all animals died within 18 min. In Gp2 and Gp3, mean arterial pressure ranged from 60-90 mm Hg during CPB. 60 min after terminating CPB in Gp2, mean arterial pressure and heart rate were decreased compared to Gp3. In Gp3, most animals maintained haemodynamic stability. 60 min after CPB, free haemoglobin in circulating blood was elevated compared to pre-trauma levels. Pulmonary water content was significantly higher in Gp2 and Gp3 than in Gp1.

CONCLUSIONS

Emergent CPB in the field can maintain haemodynamic stability and supply vital organs with sufficient blood flow, but surgery following CPB is essential to rescue patients with penetrating cardiac wounds.

Out-of-hospital cardiopulmonary arrest due to penetrating cardiac injury treated by percutaneous cardiopulmonary support in the emergency room: report of a case

Penetrating cardiac injury tends to generally be repaired without cardiopulmonary bypass in the operating room. We herein report the case of penetrating cardiac injury repaired using percutaneous cardiopulmonary support in an emergency room. A 57-year-old man attempted suicide by stabbing himself in the left anterior chest with a knife. Although the patient suffered cardiopulmonary arrest for 7 min in the ambulance, spontaneous circulation was restored following pericardiotomy through emergency left thoracotomy in the emergency room. To prevent coronary artery injury and control the massive bleeding, percutaneous cardiopulmonary support was instituted without systemic heparinization and the cardiac injury was repaired in the emergency room. The patient was then transferred to another hospital on day 46 for further rehabilitation. Percutaneous cardiopulmonary support might be helpful for treating critical patients in an emergency room, even in the case of trauma patients.