Haemodynamically stable patients with penetrating cardiac injury: The Auckland City Hospital experience

Abstract

Abstract Background The management of penetrating cardiac injuries (PCI) has evolved significantly. Haemodynamically stable patients with benign PCIs may be managed conservatively or with subxiphoid pericardial window (SPW). Whereas this approach has been adopted in high‐volume trauma centres, its applicability in low‐volume settings remains unclear. The aim of this study was to review the Auckland City Hospital (ACH) experience with the management of benign PCI in a high‐resource low‐volume setting. Methods A retrospective review was conducted over a 20‐year period from 2005 to 2024 of patients who presented to ACH with a PCI using our trauma registry. Data reviewed included demographics, injury patterns, diagnostic imaging, operative interventions and outcomes. Results During the 20‐year study period, 14 PCIs were managed by our institution. Ten (71%) were haemodynamically stable and admitted for active clinical observation. Of these, 5 (50%) deteriorated clinically or demonstrated an increased pericardial effusion size on repeat transthoracic echocardiogram (TTE). Three (75%) underwent open surgery, and one (25%) underwent an SPW. The remaining five patients remained clinically stable, with no evidence of increased pericardial effusion on serial TTE and were discharged after 48 hours of observation. There were two (20%) mortalities in the group due to expectant management and refusal of surgery. Conclusion PCIs are rare in our locality, with approximately two‐thirds presenting haemodynamically stable. In our high‐resource low‐volume environment, open cardiac exploration appears to remain the safest approach, with favourable outcomes. Selective conservatism may be difficult to apply or justify in our environment.