Blunt Cardiac Trauma: Lessons Learned From the Medical Examiner

Division of Trauma Surgery and Surgical Critical Care, University of Southern California, USC and LAC Medical Center, 1200 North State Street, Room 10-750, Los Angeles, CA 90033, USA.
The Journal of trauma (Impact Factor: 2.96). 12/2009; 67(6):1259-64. DOI: 10.1097/TA.0b013e318187a2d2
Source: PubMed

ABSTRACT The objective of this study was to analyze autopsy findings after blunt traumatic deaths to identify the incidence of cardiac injuries and describe the patterns of associated injuries.
All autopsies performed by the Los Angeles County Forensic Medicine Division for blunt traumatic deaths in 2005 were retrospectively reviewed. Only cases that underwent a full autopsy including internal examination were included in the analysis. The study population was divided into two groups according to the presence or absence of a cardiac injury and compared for differences in baseline characteristics and types of associated injuries.
Of the 881 fatal victims of blunt trauma received by the Los Angeles County Forensic Medicine Division, 304 (35%) underwent a full autopsy with internal examination and were included in the analysis. The mean age was 43 years +/- 21 years, patients were more often men (71%) and were intoxicated in 39% of the cases. The most common mechanism was motor vehicle collision (50%), followed by pedestrian struck by auto (37%), and 32% had a cardiac injury. Death at the scene was significantly more common in patients with a cardiac injury (78% vs. 65%, p = 0.02). The right chambers were the most frequently injured (30%, right atrium; 27%, right ventricle). Among the 96 patients with cardiac injuries, 64% had transmural rupture. Multiple chambers were ruptured in 26%, the right atrium in 25%, and the right ventricle in 20% of these patients. Patients with cardiac injuries were significantly more likely to have other associated injuries: thoracic aorta (47% vs. 27%, p = 0.001), hemothorax (81% vs. 59%, p < 0.001), rib fractures (91% vs. 71%, p < 0.001), sternum fracture (32% vs. 13%, p < 0.001), and intra-abdominal injury (77% vs. 48%, p < 0.001) compared with patients without cardiac injury. Of the 96 patients with a cardiac injury, 78% died at the scene of the crash and 22% died en route or at the hospital.
Cardiac injury is a common autopsy finding after blunt traumatic fatalities, with the majority of deaths occurring at the scene. Patients with cardiac injuries are at significantly increased risk for associated thoracic and intra-abdominal injuries.

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    • "The main causes of cardiac traumatisms in our environment are motor vehicle collisions. Such traumatisms are a very common finding in autopsy studies of those deceased at the scene [1]. In recent years, due to the improvement of security mechanisms in cars, the frequency of cardiac injuries has decreased. "
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    ABSTRACT: Cardiac injuries caused by knives and firearms are slightly increasing in our environment. We report the case of a 43-year-old male patient with a transmediastinal gunshot wound (TGSW) and a through-and-through cardiac wound who was hemodynamically stable upon his admission. He had an entrance wound below the left clavicle, with no exit wound, and decreased breath sounds in the right hemithorax. Chest X-ray showed the bullet in the right hemithorax and large right hemothorax. The ultrasound revealed pericardial effusion, and a chest tube produced 1500 cc. of blood, but he remained hemodynamically stable. Considering these findings, a median sternotomy was carried out, the through-and-through cardiac wounds were suture-repaired, lung laceration was sutured, and a pacemaker was placed in the right ventricle. The patient had uneventful recovery and was discharged home on the twelfth postoperative day. The management and prognosis of these patients are determined by the hemodynamic situation upon arrival to the Emergency Department (ED), as well as a prompt surgical repair if needed. Patients with a TGSW have been divided into three groups according to the SBP: group I, with SBP >100 mmHg; group II, with SBP 60-100 mmHg; and group III, with SBP <60 mmHg. The diagnostic workup and management should be tailored accordingly, and several series have confirmed high chances of success with conservative management when these patients are hemodynamically stable.
    08/2014; Volume 2014:Article ID 985097, 3 pages. DOI:10.1155/2014/985097
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    • "Cardiac rupture is rarely observed mainly because most patients die prior to reach the hospital as it was highlighted in an autopsy study performed on patients with blunt chest trauma [3]. Nevertheless, in a recent retrospective study focusing on blunt chest trauma, cardiac rupture incidence was found in only 1/2400 patients, but with a very high mortality rate of 89.2% [4]. Traumatic free-wall heart rupture management is a difficult medical and surgical challenge. "
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    ABSTRACT: This report presents a case of severe blunt chest trauma secondary to a horse riding accident with resultant free-wall rupture of the left ventricle in association with severe lung contusion. We describe the initial surgical and medical management of the cardiac rupture which was associated with a massive haemoptysis due to severe lung trauma. Extra corporeal membrane oxygenation (ECMO) support was initiated and allowed both the acute heart and lung failure to recover. We discuss the successful use and pitfalls of ECMO techniques which are sparsely described in such severe combined cardiac and thoracic trauma.
    09/2013; 2013:136542. DOI:10.1155/2013/136542
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    • "Blunt cardiac injury (BCI) is a very rare, but potentially fatal, condition that accounts for 12%–32% of trauma-related fatality [1] [2] [3]. Ruptured cardiac cavities, coronary arteries, or intrapericardial portion of major vessels typically result in death at the scene of the collision [2] [4]. Victims of relatively less severe cardiac injuries such as myocardial contusion, hemopericardium due to contusions or lacerations, valvular regurgitation, or myocardial infarction due to coronary artery injury may survive the initial trauma and thus present to the emergency department (ED) for evaluation [1] [5] [6]. "
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    ABSTRACT: Trauma patients with thoracic aortic injury (TAI) suffer blunt cardiac injury (BCI) at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG) and serum creatine kinase-MB (CK-MB) from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an elevated CK-MB or abnormal echocardiography. There were 26 patients (19 men, mean age 45.1 years, mean ISS 34.4) in the study group; 20 had evidence of BCI. Of 52 patients in the control group (38 men, mean age 46.9 years, mean ISS 38.7), eighteen had evidence of BCI. There was a significantly higher rate of BCI in trauma patients with TAI versus those without TAI (77% versus 35%, P < 0.001).
    07/2011; 2011:848013. DOI:10.1155/2011/848013
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