Blunt cardiac rupture. The Emanuel Trauma Center experience

M. J. Perchinsky, W. B. Long and J. G. Hill
Division of Trauma Services, Emanuel Hospital and Health Center, Portland, Ore., USA.

OBJECTIVE: To analyze the factors affecting outcome in patients with blunt cardiac rupture, including anatomical cardiac injury, associated injury, clinical presentation, age, mechanism of injury, diagnostic method, surgical intervention, and presence of vital signs in the field and on arrival. DESIGN: Retrospective review. SETTING: A community-based level I trauma center. PATIENTS: A consecutive series of 27 patients seen between 1984 and 1993. MAIN OUTCOME MEASURE: Survival with return to preinjury activity. RESULTS: Eleven patients (41%) survived resuscitation, surgery, and initial hospital care. Survivors had a lower mean Injury Severity Score (38) than nonsurvivors (62) (P < .05). Three (33%) of nine patients who arrived with no blood pressure or viable electrical heart rhythm survived. No patient survived rupture of two cardiac chambers. CONCLUSIONS: Patients with blunt cardiac rupture who present with cardiac arrest can survive. Nonsurvivors tend to have more associated injuries, as indicated by higher Injury Severity Scores. Our institution's overall survival rate of 41% (11/27) compares favorably with rates at other trauma centers.