Mortalidad por trauma cardiaco penetrante en un hospital de Bogotá, Colombia : análisis de factores asociados
Bolívar Saenz, Dinimo
Tarazona, Marcos Manuel
Gil Laverde, Fabian Armando
Objective: To characterize patients with penetrating cardiac injury grade II to VI describe the characteristics of trauma, surgical treatment, clinical outcome and identify factors associated with otcome. Methodology: We performed an association study in 308 patients admitted to surgery with a diagnosis of penetrating heart injury between January 1999 and October 2009. 68 cases were excluded. The series analyzed included 240 patients with cardiac wounds. We analyzed demographic, clinical, surgical and evolution, tabulated in Excel ® and analyzed in SPSS 20 ®. Results: Mean age was 27.8 years, mainly men (96%), sharp weapon injuries by 93% and 7% for projectile gun. The hemodynamic status at admission (according Ivatury) was normal 44%; Shock 34%; deep agonizing 18% and 3% fatal. 67% (n = 161) had cardiac tamponade. The degrees of cardiac injury as classified by OIS-AAST were 33% grade II, grade III 13%, grade IV 29%, 22% grade V and grade VI 3%. The pericardial window was the confirmatory method of injury in 63% and surgical incisions were 63% sternotomy and anterolateral thoracotomy 35%. Mortality was 15% (n=36). The differences in mortality between the hemodynamic status at the start of surgery, mechanism of injury and degree of injury, proved to be statistically significant (p<0.001). Conclusions: The hemodynamic status and gunshot wounds are factors associated with mortality. The subxifoidea pericardial window favors the choice and success of the sternotomy as surgical approach.