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Open Access

Selective use of pericardial window and drainage as sole treatment for hemopericardium from penetrating chest trauma

Paul J Chestovich, Christopher F McNicoll, Douglas R Fraser, Purvi P Patel, Deborah A Kuhls, Esmeralda Clark, John J Fildes
DOI: 10.1136/tsaco-2018-000187 Published 30 August 2018
Paul J Chestovich
Division of Acute Care Surgery, Department of Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
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Christopher F McNicoll
Division of Acute Care Surgery, Department of Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
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Douglas R Fraser
Division of Acute Care Surgery, Department of Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
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Purvi P Patel
Division of Acute Care Surgery, Department of Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
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Deborah A Kuhls
Division of Acute Care Surgery, Department of Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
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Esmeralda Clark
Division of Acute Care Surgery, Department of Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
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John J Fildes
Division of Acute Care Surgery, Department of Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
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Figures

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  • Figure 1
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    Figure 1

    Flow chart of patients reviewed, including all patients who underwent sternotomy or pericardialwindow for suspected penetrating cardiac injury. OIS, Organ Injury Scale; PCW+drain, pericardial window, lavage, and drainage.

  • Figure 2
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    Figure 2

    Suggested modification to the Western Trauma Association’s management strategy for stable patients with penetrating thoracic injury. FAST, Focused Assessment with Sonography for Trauma; PCW, pericardial window; TEE, transesophageal echocardiography, VATS = Video Assisted Thoracic Surgery, CXR = Chest X-Ray.

Tables

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  • Table 1

    All patients with penetrating chest trauma receiving either a pericardial window, sternotomy, or both

    N=78
    Male, n (%)73 (93.6)
    Age (years), median (IQR)29 (24–39)
    Mechanism
      Gunshot wound, n (%)28 (35.9)
      Knife stab wound, n (%)47 (60.3)
    Admission vitals
      Systolic blood pressure, median (IQR)130 (85–149)
      Heart rate, median (IQR)107 (88–121)
    Glasgow Coma Scale, median (IQR)15 (9–15)
    Exploratory laparotomy, n (%)42 (53.8)
    Hospital LOS (days), median (IQR)7 (4–11)
    ICU LOS (days), median (IQR)2 (1–5)
    Ventilator days (days), median (IQR)0 (0–1)
    Hospital mortality, n (%)16 (20.3)
    • ICU, intensive care unit; LOS, length of stay.

  • Table 2

    Comparison between patients undergoing PCW+drain after positive PCW and those undergoing sternotomy for cardiac OIS of 1–3. Median and IQR displayed for continuous variables, and quantity (%) for categorical variables. omparison using Fisher’s exact test and Wilcoxon rank-sum with p<0.05 was considered statistically significant

    PCW+drain
    N=5
    Sternotomy
    N=7
    P values
    Age (years), median29 (25–51)35 (17–52)0.63
    Male, n (%)4 (80%)7 (100%)0.42
    Knife stab wound, n (%)5 (100%)6 (86%)1.0
    Exploratory laparotomy, n (%)2 (40%)3 (43%)1.0
    Systolic blood pressure, median (IQR)144 (138–149)127 (71–145)0.57
    Heart rate, median (IQR)99 (93–110)98 (88–111)0.81
    Glasgow Coma Scale, median (IQR)15 (15–15)15 (15–15)0.40
    Revised Trauma Score, median (IQR)12 (11–12)12 (10–12)1.0
    Hospital LOS (days), median (IQR)5 (5–12)7 (4–20)0.63
    ICU LOS (days), median (IQR)4 (3–4)2 (2–3)0.18
    Ventilator days (days), median (IQR)1 (0–2)0 (0–1)0.36
    Hospital mortality, n (%)0 (0%)0 (0%)-
    • ICU, intensive care unit; LOS, length of stay; PCW+drain, pericardial window, lavage, and drainage.

Supplementary Materials

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    [tsaco-2018-000187-supp1.docx]

  • Supplementary data

    [tsaco-2018-000187-supp2.docx]

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Selective use of pericardial window and drainage as sole treatment for hemopericardium from penetrating chest trauma
Paul J Chestovich, Christopher F McNicoll, Douglas R Fraser, Purvi P Patel, Deborah A Kuhls, Esmeralda Clark, John J Fildes
Trauma Surg Acute Care Open Aug 2018, 3 (1) e000187; DOI: 10.1136/tsaco-2018-000187

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Selective use of pericardial window and drainage as sole treatment for hemopericardium from penetrating chest trauma
Paul J Chestovich, Christopher F McNicoll, Douglas R Fraser, Purvi P Patel, Deborah A Kuhls, Esmeralda Clark, John J Fildes
Trauma Surg Acute Care Open Aug 2018, 3 (1) e000187; DOI: 10.1136/tsaco-2018-000187
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Selective use of pericardial window and drainage as sole treatment for hemopericardium from penetrating chest trauma
Paul J Chestovich, Christopher F McNicoll, Douglas R Fraser, Purvi P Patel, Deborah A Kuhls, Esmeralda Clark, John J Fildes
Trauma Surgery & Acute Care Open Aug 2018, 3 (1) e000187; DOI: 10.1136/tsaco-2018-000187
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