Factors influencing outcome in stab wounds of the heart

The purpose of this study was to identify factors associated with unfavorable out-come following stab wounds to the heart in order to improve selection of patients who may benefit from aggressive resuscitative efforts. Preoperative and operative variables were reviewed for all patients treated for cardiac stab wounds at a level I trauma center from 1987 to 1993 in an attempt to identify factors influencing survival. Twenty-nine (53%) of the 55 patients who were resuscitated following stab wounds to the heart during the study period survived. Although profound hypotension (systolic blood pressure <40 mm Hg), cardiopulmonary resuscitation, and emergency room thoracotomies were associated with poor outcome, none were uniformly predictive of death. Some patients survived with each of these characteristics. We recommend that all patients suspected of having cardiac stab wounds be fully resuscitated and undergo thoracotomy, as significant survival can be achieved and death is not always the outcome.