Fifty-seven patients with acute penetrating injuries of the heart were reviewed. Forty-nine had stab wounds and eight had gunshot wounds. Thirty-six patients were treated initially by pericardicentesis and observation, and 16 required immediate operation. All patients with gunshot wounds required operation either immediately or later. Results were evaluated for three groups of patients treated: (1) pericardicentesis and observation; (2) pericardicentesis followed by subsequent thoracotomy; and (3) immediate operation. Fatality rates for the three groups were 5%, 19%, and 13%, respectively. Thirty-eight percent of the patients were managed successfully by pericardial aspiration alone, but aspiration was observed to be effective in 55% of the patients in whom it was attempted as definitive treatment. Operative treatment is preferred for (1) continued bleeding; (2) failure to respond to aspiration; (3) recurrent tamponade after aspiration; (4) cardiac arrest; and (5) gunshot wounds.
Hewitt RL, Smith AD, Weichert RF, Drapanas T. Penetrating Cardiac InjuriesCurrent Trends in Management. Arch Surg. 1970;101(6):683-688. doi:10.1001/archsurg.1970.01340300039008