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01/02/2017

Echo: Pour le thorax surtout

Traumatic cardiac injury: Experience from a level-1 trauma centre

Mishra B. et Al. Chin J Traumatol. 2016 Dec 1;19(6):333-336.

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Disposer d'un appareil d'échographie est d'un grand intérêt. Encore faut-il maîtriser cette technique (1) sous peine de se tromper dans les priorités de prise en charge. Le recours a cette technique reste débattu pour la prise en charge de traumatismes pénétrants. L'échographie thoracique est probablement à valeur ajoutée tant sur l'imagerie pleurale que péricardique. C'est ce que présente ce travail. Ce document rapporte également l'inefficacité en terme de survie de péricardocentèse pourtant prôné par l'ATLS.

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Traumatic cardiac injury (TCI) is a challenge for trauma surgeons as it provides a short thera- peutic window and the management is often dictated by the underlying mechanism and hemodynamic status. The current study is to evaluate the factors influencing the outcome of TCI.

METHODS:

Prospectively maintained database of TCI cases admitted at a Level-1 trauma center from July 2008 to June 2013 was retrospectively analyzed. Hospital records were reviewed and statistical analysis was performed using the SPSS version 15.

RESULTS:

Out of 21 cases of TCI, 6 (28.6%) had isolated and 15 (71.4%) had associated injuries. Ratio be- tween blunt and penetrating injuries was 2:1 with male preponderance. Mean ISS was 31.95. Thirteen patients (62%) presented with features suggestive of shock. Cardiac tamponade was present in 12 (57%) cases and pericardiocentesis was done in only 6 cases of them. Overall 19 patients underwent surgery. Perioperatively 8 (38.1%) patients developed cardiac arrest and 7 developed cardiac arrhythmia. Overall survival rate was 71.4%. Mortality was related to cardiac arrest (p = 0.014), arrhythmia (p = 0.014), and hemorrhagic shock (p =0.04). The diagnostic accuracy of focused assessment by sonography in trauma (FAST) was 95.24%.

CONCLUSION:

High index of clinical suspicion based on the mechanism of injury, meticulous examination by FAST and early intervention could improve the overall outcome.

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