Use of cardiopulmonary bypass to salvage patients with multiple-chamber heart wounds

Background: The need for cardiopulmonary bypass in the treatment of penetrating heart injuries is debated. Objectives: To review our experience with penetrating heart injuries and determine the indications and outcome for cardiopulmonary bypass. Design: Retrospective review. Setting: A university- based, level I trauma center. Patients: All victims of penetrating heart injury presenting between July 1, 1989, and December 31, 1995. Methods: Medical records were reviewed for demographic and physiological data, operative findings, and outcome. Results: Overall survival for 106 patients with penetrating heart injury was 55%. In an effort to resuscitate the heart, 4 patients with unresponsive cardiogenic shock were placed on cardiopulmonary bypass; none survived. Of 30 patients with multiple-chamber injuries, 11 presented with signs of life and 7 survived. Cardiopulmonary bypass was essential to repair complex injuries in 2 of the 7 survivors. Conclusion: Cardiopulmonary bypass was ineffective in salvaging patients with cardiogenic shock but was essential in some patients with complex multiple-chamber cardiac injuries that could not be exposed and repaired by other means.