The importance of prompt transport of salvage of patients with penetrating heart wounds

Abstract

The impact on mortality of stabilization in the field before transport of patients with penetrating heart injuries is unknown. This retrospective study compares patients promptly transported with minimal therapy after penetrating cardiac injuries with such patients who had received prolonged attempts at stabilization in the field. During the period of study from 1979 to 1981 23 patients with penetrating wounds of the heart were seen at our institution. The overall mortality was 78%. Forty-three per cent of patients were not salvageable on the basis of extensive anatomic injury or excessive time delays before ambulance arrival. Fifty-six per cent were alive at the time of ambulance arrival with systolic blood pressures of greater than 90 mm Hg. All patients were injured within 10 minutes' rapid transport time from our institution. Approximately one half the patients were treated with 'scoop and run' technique with minimal in-field treatment. Delay from the arrival of the ambulance until definitive surgical correction was less than 9 minutes. The remaining patients were treated with extensive in-field attempts at stabilization with a delay of 25 minutes or more from ambulance arrival until definitive treatment (mean, 40 minutes). Patients with potentially salvageable injuries had a survival rate of 38%. In this group of patients, a salvage rate of 80% was achieved if transport delays were minimized. In contrast, no patients in whom field resuscitation with concomitant prolonged prehospital delay survived. These data suggest that prompt transport to the hospital without attempts at field resuscitation provides a better chance for survival among patients with penetrating heart wounds.