Haemopericardium in stable patients after penetrating injury: is subxiphoid pericardial window and drainage enough? A prospective study.

AIM This prospective study was undertaken to evaluate whether stable patients with haemopericardium could safely be managed with subxiphoid pericardial window (SPW) and drainage only. PATIENTS AND METHODS From July to December 2001, all stable patients with haemopericardium diagnosed by SPW, who did not have immediate active bleeding, were subjected to sternotomy to grade the injury using the American Association for the Surgery of Trauma (AAST)-cardiac injury score. The data of all patients with penetrating cardiac injuries for the year 2001 is presented to place into perspective the spectrum of cardiac injuries seen. RESULTS Fourteen patients qualified for inclusion into the study. Ten (71.4%) patients had Grade I-III cardiac injuries. These could have safely been managed by SPW and drainage alone. The remaining four patients with Grade IV injuries showed no active bleeding at the time of sternotomy. During the first half of the year, seven patients diagnosed with haemopericardium were managed with SPW and drainage only. These seven patients showed no procedure-related complications and were well at 2-week follow-up. Ten patients presented with acute cardiac tamponade. There was a single death in the latter group. CONCLUSION This preliminary prospective study, though limited by small numbers, shows that 10/14 (71%) of stable patients with haemopericardium had unnecessary non-therapeutic sternotomy and could have safely been managed with SPW and drainage only. Further prospective, randomised studies are required to confirm the good outlook.