Stab Wounds of the Heart. Report of Two Consecutive Survivors Involving Heroic Measures and Seemingly Fatal Acidemia

There are four major considerations in the effective resuscitation of the patient with penetrating wounds of the heart. Prehospital care and transport must be appropriate and rapid, using a modified load-and-go approach. Emergency Department thoracotomy must be considered and performed immediately upon the patient's arrival at the hospital. Descending thoracic aortic occlusion is the most useful maneuver in maintaining perfusion of the heart and brain until hypoperfusion can be corrected. The severe acidemia frequently exhibited by agonal patients was corrected in both cases presented (in our first case, the pH was initially 6.47, the lowest ever recorded in a deficit-free survivor) by application of the above-mentioned modalities. In conclusion, we found that the use of these heroic measures in treating two victims of stab wound of the heart, despite the discouraging results published by some other centers, achieved deficit-free survival for both patients. We believe that in cases of penetrating chest trauma, it is inappropriate to base the use of Emergency Department thoracotomy solely on the observance of signs of life in transit to the hospital. Mandatory thoracotomy should be applied in these cases.