Severe blunt thoracic trauma can disrupt cardiac structures — including valves, the interventricular septum, or the ventricular wall — producing cardiac tamponade. When the patient is not haemodynamically unstable and is able to survive transfer to an operating room, a structured, bridging approach applies before definitive surgical repair.
This protocol addresses patients with clinical or echocardiographic evidence of severe cardiac injury — ruptured valve, septum, or ventricular wall — causing cardiac tamponade, who remain sufficiently stable for transfer to surgical care. Emergent surgical consultation is an essential component of management in this presentation.
Management involves a drainage-based intervention to decompress tamponade physiology while the patient is prepared for definitive surgical repair. In certain injury patterns, this drainage may be sustained as a bridge to the operating room. The complete structured regimen — including approach selection, escalation criteria, and sequencing — is in the full protocol.
It is imperative that patients with clinical or echocardiographic evidence of severe cardiac injury, i.e., ruptured valve, septum, or ventricular wall causing cardiac tamponade, receive emergent surgical consultation.
Among unstable patients who may not survive transfer to an operating room, emergency department thoracotomy, rather than pericardiocentesis, may be the best treatment for cardiac tamponade.
If tamponade is suspected either clinically or by ultrasound, pericardiocentesis can be performed.
Tamponade that results from an atrial tear may be amenable to pericardiocentesis with periodic drainage using a pigtail catheter until definitive surgical repair can be performed.
DOI: 10.1186/s13019-023-02146-z View source ↗