Subxiphoid pericardial window to exclude occult cardiac injury after penetrating thoracoabdominal trauma

Background An occult cardiac injury may be present in patients with an acute abdomen after penetrating thoracoabdominal trauma. This study assessed the use of a subxiphoid pericardial window (SPW) as a diagnostic manoeuvre in this setting. Methods This was a retrospective review of a trauma database (2001–2009). Patients presenting with a penetrating thoracoabdominal injury with an acute abdomen, and in whom there was concern about a potential cardiac injury from the site or tract of the injury, were included. Results Fifty patients with an indication for emergency laparotomy underwent a SPW for a possible cardiac injury. An occult haemopericardium was present at SPW in 14 patients (28 per cent) mandating, median sternotomy. Nine cardiac injuries (18 per cent) were identified including five tangential injuries and four perforations. The specific complication rate relating to the SPW was 2 per cent. Conclusion The SPW is a useful technique at laparotomy to identify cardiac injuries in patients with penetrating thoracoabdominal injuries.

British Journal of Surgery
Posted on: Thursday, August 08, 2013 5:14 PM
Author: M. Hommes, A. J. Nicol, J. van der Stok, I. Kodde, P. H. Navsaria
Subject: Subxiphoid pericardial window to exclude occult cardiac injury after penetrating thoracoabdominal trauma

Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm

 

 

 

Background A substantial proportion of patients with a ruptured abdominal aortic aneurysm (rAAA) die outside hospital. The objective of this study was to estimate the total mortality, including prehospital deaths, of patients with rAAA. Methods This was a systematic review and meta-analysis following the MOOSE guidelines. The Embase, MEDLINE and Cochrane Library databases were searched. All population-based studies reporting both prehospital and in-hospital mortality in patients with rAAA were included. Studies were assessed for methodological quality and heterogeneity, and pooled estimates of mortality from rAAA were calculated using a random-effects model. Results From a total of 3667 studies, 24 retrospective cohort studies, published between 1977 and 2012, met the inclusion criteria. The quality of included studies varied, in particular the method of determining prehospital deaths from rAAA. The estimated pooled total mortality rate was 81 (95 per cent confidence interval 78 to 83) per cent. A decline in mortality was observed over time (P = 0·002); the pooled estimate of total mortality in high-quality studies before 1990 was 86 (83 to 89) per cent, compared with 74 (72 to 77) per cent since 1990. Some 32 (27 to 37) per cent of patients with rAAA died before reaching hospital. The in-hospital non-intervention rate was 40 (33 to 47) per cent, which also declined over the years. Conclusion The pooled estimate of total mortality from rAAA is very high, although it has declined over the years. Most patients die outside hospital, and there is no surgical intervention in a considerable number of those who survive to reach hospital.

British Journal of Surgery
Posted on: Wednesday, September 04, 2013 7:46 PM
Author: J. J. Reimerink, M. J. van der Laan, M. J. Koelemay, R. Balm, D. A. Legemate
Subject: Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm