Blunt cardiac trauma: a narrative review

Abstract

Objective: This review aims to summarize the literature regarding blunt cardiac trauma (BCT), focusing on the mechanism of injury, presentations, diagnostic, and treatment approaches to provide an up-to-date perspective and to identify the areas requiring further investigation.

Background: BCT is a relatively rare, but likely underdiagnosed, consequence of blunt chest trauma. BCT occurs in less than 10% of all trauma admissions although it is responsible for approximately 25% of traumatic deaths. BCT often occurs due to forceful impact, rapid deceleration, or crush injuries and the most common causes include motor vehicle accidents, pedestrians struck by motor vehicles, and falls from a significant height. While BCT is certainly an important condition with significant clinical implications, the current literature is limited comprised of mainly case reports. BCTs are often complex cases with various presentations, comorbid injuries, diagnostic modalities, and treatments.

Methods: PubMed was searched for retrospective, prospective, randomized control trials, case report studies, and previous related reviews investigating BCT published from January 1, 1985 to February 1, 2021. Exclusion criteria included if the full length manuscript was not available and if insufficient data was provided regarding the patient outcomes or the case presented in case reports.

Conclusions: A wide variety of injuries, mechanisms, presentations, and treatments are possible with BCT. Commonalities in initial investigations include a thorough history and physical exam where appropriate, lab work to evaluate patient status, and imaging to diagnose structural injuries. Treatment often begins with stabilization of the patient and rapid initiation of interventions aimed at underlying structural or rhythm abnormalities. As the current literature is limited, further study into BCT is necessary. As BCT is relatively rare and occurs sporadically at individual centers, widespread data collection from BCT patients regarding their treatment and outcomes is essential in order to collect the required data for retrospective or prospective studies. The widespread establishment of multicenter or national databases may be a solution to address the limited data in this field allowing identification of optimal treatments for BCT patients, addressing the limitations in the field of BCT, and allow the continued improvement in the outcomes of patients who experience BCT.

Keywords: Trauma; blunt cardiac injury; cardiac surgery.

Figure 1

Illustrations of common injuries resulting from blunt cardiac trauma and key points regarding each injury. Illustrations are demonstrating (A) cardiac contusion, (B) a normal heart (left) and aortic valve regurgitation (right), (C) normal coronary artery (top) and dissected coronary arteries (middle and bottom), (D) a normal aorta (left) and an aortic dissection with entry tear (right), (E) structural injuries with a ventricular septal defect (left) and free wall rupture (right), (F) a normal heart and pericardium (left) and heart with hemopericardium (right), (G) a normal heart within the pericardium (left) and a subluxed heart through a pericardial rupture (right), (H) ECG depicting ventricular fibrillation (top) and ventricular tachycardia (bottom). RBBB, right bundle branch block; ECG, electrocardiogram; AV, aortic valve; LAD, left anterior descending; LMCA, left main coronary artery; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; BP, blood pressure; JVD, jugular venous distension; Vfib, ventricular fibrillation; Vtach, ventricular tachycardia; CT, computerized tomography.