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Blunt traumatic cardiac rupture: Therap

eutic options and outcomes
Yu-Yun Nan et al.
Injury, Int. J. Care Injured 40 (2009) 938945
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Cente
r,
Chang Gung University, College of Medicine, 199 Tun-Hwa N Rd, Taipei 105, Taiwan, ROC

Traumatic pericardial effusion: Impact o

f diagnostic and surgical approaches
Yao-Kuang Huang et al.
Resuscitation 81 (2010) 16821686
Division of Thoracic and Cardiovascular Surgery and Heart Failure Center, Chang Gung
Memorial Hospital, Linkou Center, Chang Gung University, College of Medicine, Taiwan, ROC

OUTLINE
Blunt traumatic cardiac rupture: Therapeutic options and outcomes
Introduction
Patients and Methods
Statistical Analysis
Results
Discussion
Traumatic pericardial effusion: Impact of diagnostic
and surgical approaches

 Blunt traumatic cardiac rupture: Therapeutic o

ptions and outcomes

Introduction
Patients and Methods
Statistical Analysis
Results
Discussion

INTRODUCTION
cardiac rupture following blunt thoracic trauma: rarely encount
ered clinically
Incidence of blunt traumatic cardiac rupture among hospital tra
uma admission: 0.16% ~ 2%
Few trauma centers have developed protocols
Review of their experience

 Blunt traumatic cardiac rupture: Therapeutic o

ptions and outcomes
Introduction

Patients and Methods

Statistical Analysis
Results
Discussion

PATIENTS AND METHODS

All patients surgically diagnosed with blunt traumatic cardiac rupture
between March 2003 and June 2008 were included.
The following information was collected: age, sex, mechanism of inj
ury, initial effective diagnostic tool used for diagnosing blunt traumat
ic cardiac rupture, location and size of the cardiac injury, associated i
njury and injury severity score (ISS), reversed trauma score (RTS), s
urvival probability of trauma and injury severity scoring (TRISS), vit
al signs and biochemical laboratory data on arrival at the trauma cent
re, time elapsed from injury to diagnosis and surgery, surgical details,
hospital course, and final outcome. In-hospital mortality was defined
as death within 30 days of trauma.

 Blunt traumatic cardiac rupture: Therapeutic o

ptions and outcomes
Introduction
Patients and Methods

Statistical Analysis
Results
Discussion

STATISTICAL ANALYSIS
1.
2.
3.

Unpaired two-tailed Student`s t-test

Two-tailed Fisher`s exact test
Two-sample Wilcoxson rank-sum test

P-value < = 0.05

Software: STATA statistics/Data Analysis v8.0

 Blunt traumatic cardiac rupture: Therapeutic o

ptions and outcomes
Introduction
Patients and Methods
Statistical Analysis

Results
Discussion

RESULTS
PatientsTable 1 and 2
Comparison of the survivors and fatalities Table 3

TABLE 1
???

TABLE 2 (1/5)

TABLE 2 (2/5)

TABLE 2 (3/5)

sternotomy

cardiorrhaphy

TABLE 2 (4/5)

TABLE 2 (5/5)

ECLS (V-A mode)??

RESULTS
PatientsTable 1 and 2

Comparison of the survivors and fa

talities Table 3

COMPARISON OF THE SURVIVORS AND

FATALITIES

 Blunt traumatic cardiac rupture: Therapeutic o

ptions and outcomes
Introduction
Patients and Methods
Statistical Analysis
Results

Discussion

DISCUSSION
Cardiac rupture mechanism:
1. Cardiac squeezing between sternum and spine
2. Rapid deceleration disruption of the connection of vena cava
/pulmonary v. between atria

DISCUSSION

Fig.2 The protocol of management of suspected blun

t cardiac rupture

STUDY LIMITATIONS
1.

A small retrospective characteristic of heterogeneity of the coho

rt is the major limitation of this investigation

2.

The first study to analyze the application of FAST, various ther

apeutic protocols, and risk factors

CONCLUSION
1.

Improves previous research

2.

Multi-organ traumatic injury impact the survival

INTRODUCTION
In trauma patients with chest injuries, traumatic peri
cardial effusion is an important scenario to consider
because of its close linkage to cardiac injury. Even
with advances in imaging, diagnosis remains a cha
llenge and use of which surgical approach is cont
roversial.
This study reviews the treatment algorithm, surg
ical outcomes, and predictors of mortality for tra
umatic pericardial effusion.

CONCLUSION
Precise diagnoses of traumatic pericardial effusions
are still challenging and easily omitted even with F
AST, repeat cardiac echo and CT. The number of
patients with traumatic pericardial effusion requirin
g surgical repair is high. Standardized therapeutic p
rotocol, different surgical approaches have not impa
ct on survival. Correct identification, prompt drai
nage, and preparedness for concomitant cardiac
repair seem to be the key to better outcomes.

THANKS FOR YOUR ATTEN

TION~~~

REFERENCE

Nan YY, Lu MS, Liu KS, Huang YK, Tsai FC, Chu JJ, Lin PJ. Blu
nt traumatic cardiac rupture: therapeutic options and outcomes. In
jury. 2009 Sep;40(9):938-45

Huang YK, Lu MS, Liu KS, Liu EH, Chu JJ, Tsai FC, Lin PJ. Tra
umatic pericardial effusion: Impact of diagnostic and surgical appr
oaches. Resuscitation. 2010 Dec;81(12):1682-6

http://www.nhi.gov.tw/
TRAUMA.ORG
http://www.trauma.org/archive/scores/rts.html
http://www.trauma.org/archive/scores/triss.html