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Sternotomy or Drainage for a Hemopericardium After Penetrating Trauma: A Randomized Controlled Trial

Nicol, Andrew J. FCS, PhD*; Navsaria, Pradeep H. FCS, MMed*; Hommes, Martijn MD*; Ball, Chad G. MD; Edu, Sorin FCS*; Kahn, Delawir FCS, ChM*

doi: 10.1097/SLA.0b013e31829069a1
Randomized Controlled Trials

Objective: To determine if stable patients with a hemopericardium detected after penetrating chest trauma can be safely managed with pericardial drainage alone.

Background: The current international practice is to perform a sternotomy and cardiac repair if a hemopericardium is detected after penetrating chest trauma. The experience in Cape Town, South Africa, on performing a mandatory sternotomy in hemodynamically stable patients was that a sternotomy was unnecessary and the cardiac injury, if present, had sealed.

Methods: A single-center parallel-group randomized controlled study was completed. All hemodynamically stable patients with a hemopericardium confirmed at subxiphoid pericardial window (SPW), and no active bleeding, were randomized. The primary outcome measure was survival to discharge from hospital. Secondary outcomes were complications and postoperative hospital stay.

Results: Fifty-five patients were randomized to sternotomy and 56 to pericardial drainage and wash-out only. Fifty-one of the 55 patients (93%) randomized to sternotomy had either no cardiac injury or a tangential injury. There were only 4 patients with penetrating wounds to the endocardium and all had sealed. There was 1 death postoperatively among the 111 patients (0.9%) and this was in the sternotomy group. The mean intensive care unit (ICU) stay for a sternotomy was 2.04 days (range, 0–25 days) compared with 0.25 days (range, 0–2) for the drainage (P < 0.001). The estimated mean difference highlighted a stay of 1.8 days shorter in the ICU for the drainage group (95% CI: 0.8–2.7). Total hospital stay was significantly shorter in the SPW group (P < 0.001; 95% CI: 1.4–3.3).

Conclusions: SPW and drainage is effective and safe in the stable patient with a hemopericardium after penetrating chest trauma, with no increase in mortality and a shorter ICU and hospital stay. ( Identifier: NCT00823160)

A single-center randomized controlled study to determine if stable patients with a hemopericardium detected after penetrating chest trauma can be safely managed with pericardial drainage via a subxiphoid pericardial window as opposed to a median sternotomy.

*Trauma Center, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; and

Department of Surgery, University of Calgary, Calgary, Canada.

Reprints: Andrew J. Nicol, FCS, PhD, Trauma Center, Groote Schuur Hospital, University of Cape Town, Anzio Rd, Cape Town 7925, South Africa. E-mail:

Disclosure: Supported by funding from the Medical Research Council of South Africa. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.