Massachusetts Chapter of the American College of Surgeons

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Outcomes in Major Blunt Traumatic Cardiac Injuries
Reginald Alouidor, MD FACS Francesca Izzo, MD Elizabeth Santone, MD Aixa Perez-Carabello, MS MPH Nicole Corriveau Kristine Kramer, MD Edward Kelly, MD FACS Eleanor Winston, MD FACS Tyler Putnam, MD FACS Gabriel Ryb, MD FACS
University of Massachusetts Medical Center-Baystate Health, Springfield, MA

Background: Major blunt traumatic cardiac injuries are rare and devastating. The management of these patients ranges from observation to emergent resuscitative thoracotomy. There are few studies reviewing the management of these patients. The purpose of this case study was to provide an update on severe blunt cardiac injury.
Methods: A retrospective review of patients with severe blunt traumatic cardiac injury from a single level 1 trauma center between January 2009 and December 2019.
Results: Of the 12,583 adult trauma patients admitted to the adult Trauma Service, 27 sustained major blunt cardiac injuries. The overall survival rate of these patients was 66% (18 out of 27). Of the 3 patients who arrived in the trauma bay pulseless, 0 survived. Of the 2 patients who lost pulses in the trauma bay, 1 survived. 15 patients required immediate operative intervention. Of those patients, 7 required cardiac surgery involvement. 1 patient required transvenous pacing and 1 patient was scheduled for a semi elective aortic valve replacement. The survival rate of patients requiring immediate operative intervention was 47% (7 out of 15). The survival rate of patients not requiring immediate operative intervention was 92% (11 out of 12).
Conclusion: Major blunt cardiac injury is rare and potentially devastating but good outcomes are not uncommon which justifies aggressive treatment. In this study, patients who arrived hemodynamically unstable, or required operative intervention, had poorer outcomes than those who do not require operative intervention.


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