• Adolfo González-Hadad, Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Natalia Padilla, Mauricio Millán, Alberto García, Jenny Marcela Vidal-Carpio, Luis Fernando Pino, Mario Alain Herrera, Laureano Quintero, Fabian Hernández, Guillermo Flórez, Fernando Rodríguez-Holguín, Alexander Salcedo, José Julián Serna, María Josefa Franco, Ricardo Ferrada, and Pradeep H Navsaria.
• Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.
• Colomb Medica. 2021 Apr 3; 52 (2): e4034519e4034519.

AbstractDefinitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.Copyright © 2021 Colombia Medica.

38 keywords...

hide…