1. Pericardial drainage did not lead to more complications than sternotomy.
2. Pericardial drainage decreased the likelihood of ICU admission and led to shorter ICU stays on average than sternotomy .
3. Pericardial drainage led to shorter hospitalizations compared to sternotomy.
Evidence Rating Level: 1 (Excellent)
Study Rundown: This novel study reevaluated the international standard of treatment of immediate sternotomy for hemopericardium in patients with penetrating trauma. The authors compared sternotomy to pericardial drainage for hemopericardium, and found that pericardial drainage led to shorter hospital stays, shorter ICU stays, and similar, if not less severe, complications during the hospitalization. Patients were randomized, with comparable patient demographics and no statistically significant differences after randomization. Additionally, the measurable differences were statistically significant across several critical categories. Not only is the pericardial drainage procedure less morbid and had no mortalities in this study, but it also demonstrated significantly less resource utilization (i.e. ICU and overall hospital stay), which may have wider policy implications. Primary limitations included the short and lack of follow up for all patients. The patients and surgeons involved in this trial were not blinded to intervention. It would be prudent to follow these patients for a longer period of time after discharge to ensure they do not develop any unforeseen complications. Follow up echocardiography may also be helpful in future studies.
Relevant Reading: Penetrating thoracic injuries: what we have learnt
In-Depth [randomized controlled trial]: This study evaluated the management of patients presenting with penetrating trauma that were stable and found to have hemopericardium during a sub-xiphoid pericardial window (SPW) procedure. 55 patients were randomized into the current standard of care of immediate sternotomy for exploration, and 56 patients into pericardial drainage. Complications were measured using the Clavien-Dindo classification. Two life-threatening complications and one death occurred, all in sternotomy patients. ICU stay and hospital stay were also measured. No overall differences in specific complications or overall complications was observed between the two groups (P = 0.412). 39 of 55 patients in the sternotomy group required ICU management post-operatively compared to only 9 of 56 patients in the drainage group. Average ICU length of stay was longer in sternotomy patients (2.04 vs 0.25 days, P < 0.001). Mean overall hospital stay was also longer for sternotomy patients (6.5 vs. 4.1 days, P < 0.001). No patient in the drainage group required delayed surgery for cardiac tamponade or pericardial effusion, and all of the patients were able to be discharged home.
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