Isabella Caicedo-Holguin (Cali / CO), Alberto Federico Garcia (Cali / CO), Juan Carlos Puyana (Pittsburgh, PA / US), Maria Josefa Franco (Cali / CO), Julian Chica (Bogotá / US), Carlos Gallego (Bogotá / US; Rochester, MN / US), Laura Hernandez (Cali / CO), Elizabeth Cifuentes (Pittsburgh, PA / US), Carlos Ordoñez (Cali / CO)
Abstract text (incl. references and figure legends)
Introduction: Throughout the years several authors have described the utility of echocardiography in the detection of cardiac injuries and a successful non-operative management (NOM) of patients with penetrating precordial trauma who are stable and negative for hemopericardium. Yet, a NOM protocol (NOMP) for patients with positive hemopericardium without instability nor signs of cardiac tamponade has not been proposed.
Methods: Patients with penetrating precordial trauma from 2019 to 2021 who had a positive E-FAST for hemopericardium, who were stable at arrival and had no signs of cardiac tamponade were included. They underwent the NOMP at our institution which consists in close monitorization and serial cardiac ultrasounds for 72-96 hours. If during follow-up, the patient presented hemodynamic instability or cardiac tamponade, surgery was performed. If on the contrary, the patient remained stable and asymptomatic, discharge was considered.
Results: 14 patients with positive hemopericardium were reported. The median (IQR) age was of 34.5 years, 92.86% were males and 64.29% were gunshot wounds. 5 patients presented transient hypotension: 4 due to hemothorax and 1 due to hemoperitoneum. None of the patients presented instability nor cardiac tamponade during the NOMP. Median(IQR) ISS was of 10.5(10-14) and NISS of 16.5(11-27). 4 pericardial windows(PW) were performed; 2 positive, one in which a sternotomy was performed, they both reported contusions in right ventricle and right atrium and they were managed conservatively. None of the patients died. Median(IQR) ICU length of stay was 2(2-4) and hospitalization was of 7(3-10).
Conclusion: The NOMP was successful in all 14 patients, none of the patients died. 2 patients with positive PW were stable and the injuries reported had no active bleeding and were managed conservatively. This strategy must be considered to avoid unnecessary surgical procedures in these patients. Further studies with bigger samples are required.
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