Survival Beyond 72 hours After Penetrating Arrow Injury to the Heart Managed Without Cardiopulmonary Bypass: A Case of Delayed Physiologic Stabilization and Off-Pump Repair

Penetrating chest injuries are associated with high mortality because visceral and vascular structures are situated close together, and injury to these can be devastating due to the limited time for resuscitation. Such injuries often cause massive hemorrhage, tension pneumothorax, hemothorax, cardiac tamponade, or direct penetration of the heart and great vessels. Survival in penetrating chest injuries involving the heart, especially with delayed hospital presentation, is very uncommon. The mechanism of penetration significantly influences the diagnostic approach and necessary interventions. Bedside POCUS protocols, such as eFAST, RUSH, and BLUE, enable immediate resuscitation before further investigations. High-velocity injuries like gunshots and crossbow bolts are linked to high mortality due to rapid tissue destruction caused by kinetic energy transfer. Certain pathological conditions, such as cardiac tamponade or effusion, may sometimes be beneficial in these injuries. We present a case of an accidental penetrating arrow injury to the chest, piercing the heart, yet the patient survived after more than three days of delayed transfer to higher care with hemopneumothorax and mediastinal involvement. Survival after a penetrating chest injury through the heart is very rare. Prompt, rapid resuscitation with a multidisciplinary approach can improve outcomes. However, the prognosis depends on factors such as the type and location of the injury, the speed of medical response, the presence of cardiac tamponade, and the patient's pre-existing clinical condition.