Blunt cardiac injury: analysis of 348 patients

Abstract

Objective To explore the early diagnosis, therapeutic methods and efficacy for blunt cardiac injury (BCI). Methods All BCI patients from September 2003 to August 2018 were studied retrospectively in respect of sex, age, cause of injury, diagnostic methods, therapeutic procedures, and outcome. The patients were divided into two groups: nonoperative group (n=305) and operative group (n=43). The two groups were compared and analyzed. Results Totally 348 BCI patients accounted for 18.3% of 1 903 patients with blunt thoracic injury (BTI), and the mortality rate was 10.1%. The main cause of injury was traffic accident with an incidence of 48.3%. The diagnostic methods included electrocardiogram (ECG), enzymes and troponin I, echocardiography, and CT scanning, or confirmed by emergency thoracatomy. In the nonoperative group, patients were mainly myocardial contusion, with a mortality rate of 6.9%. In the operative group, patients were mainly cardiac rupture and pericardial hernia, and the mortality was 32.6%. The incidence of negative ECG between the two groups was not significantly different (16.7% vs 11.6%, P>0.05). The incidence of shock and mortality in the operative group were significantly higher than those in the the nonoperative group (P<0.01). The number of death directly resulted from BCI in the operative group was greater than that in the nonoperative group (P<0.05). Conclusions For BTI patients, BCI must be highly suspected, and necessary examinations should be given. To manage myocardial contusion without surgery, it is necessary to protect the heart, alleviate edema of myocardium, and control arrhythmia with drugs. To deal with those patients requiring operation, early recognition and expeditious thoracotomy are essential. Key words: Wounds and injuries; Blunt cardiac injury; Myocardial contusion; Cardiac rupture; Emergent thoracotomy