Whose side is time on? Effect of preoperative factors on survival in penetrating left heart injuries

Objectives: Due to high mortality rates, cardiac trauma management is a major challenge for emergency trauma teams. Patients’ clinical presentations vary according to the type and severity of injury. Despite optimal interventions, death may be unavoidable if the left heart is severely injured. Methods: Between January 2012 and January 2022, 24 patients were evaluated in the emergency department with a diagnosis of penetrating left heart injury and underwent urgent surgery. Patients in the survival and non-survival groups were retrospectively evaluated based on preoperative prognostic factors and statistically analyzed. Results: Gunshot wounds, left ventricular injuries, and injury severity were found to be associated with mortality. In addition, cardiac tamponade and the preoperative pH and lactate levels associated with tamponade were found to determine mortality. Hemodynamic shock status was found to be more favorable than tamponade status despite the associated unstable hemodynamics. Transfer time to surgery was found to be highly predictive of mortality. Conclusion: Since penetrating heart injuries are life-threatening emergencies, their immediate transport to the hospital and prompt intervention are important. If a cardiac injury is suspected, immediately transferring the patient to the operating room without wasting time on further diagnostic tests can be life-saving.