Citation

Jhunjhunwala R, Dente CJ, Keeling WB, Prest PJ, Dougherty SD, Gelbard RB, Long WB, Nicholas JM, Morse BC. Am. J. Surg. 2016; 212(2): 352-353.

Affiliation

Emory University Department of Surgery, Grady Memorial Hospital, 69 Jesse Hill Jr. Drive SE, Glenn Building Suite 308, Atlanta, GA 30303, USA. Electronic address: bcmorse@emory.edu.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.amjsurg.2015.07.034

PMID

26899959

Abstract

BACKGROUND: Life-threatening conduction abnormalities after penetrating cardiac injuries (PCIs) are rare, and rapid identification and treatment of these arrhythmias are critical to survival. This study highlights diagnosis and management strategies for conduction abnormalities after PCI.

METHODS: Patients with life-threatening arrhythmias after PCI were identified at an urban, level I trauma center registry.

RESULTS: Seventy-one patients survived to reach the hospital after PCI. Of these, 3 (4%) survivors (male = 3, mean age 41.3, median injury severity score = 25) had critical conduction abnormalities after cardiorrhaphy. All patients had multichamber and atrioventricular nodal injury. After initial cardiorrhaphy and control of hemorrhage, all patients had sustained hypotension with bradycardia from complete heart block. Two patients had ventricular septal defects requiring repair. All 3 patients survived.

CONCLUSIONS: Rapid recognition of injury to the cardiac conduction system after PCI as a source of sustained hypotension is essential to early restoration of cardiac function and survival.

Language: en