Penetrating cardiac injuries usually result in an excessive bleeding and a cardiac tamponade with a very high mortality. If patients reach hospital alive, or within 15 minutes after no signs of life are found, an emergency department thoracotomy (EDT) can be indicated. However, the indications and outcome of this procedure have been debated. We report a 40 year old male that sustained a cardiac stab injury, causing a cardiac tamponade and a circulatory arrest. By performing an EDT with a pericardiotomy and direct cardiac massage, his circulation could be restored and the perforation of the heart sutured. Twelve months later the patient is in good health. This case shows that an EDT can be life saving in patients with penetrating cardiac injuries.

Fig. 1a-c. Different types of emergency thoracotomy (see text for details). A. Sternotomy.B. Left anterolateral thoracotomy. C. Clam-shell thoracotomy. Drawing: Bergros Kristin Johannesdottir.

Fig. 2. The site of the injury. Drawing: Bergros Kristin Johannesdottir.

Fig. 3. Intraoperative photo showing the two cm hole on the right ventricular wall which was repaired using a Teflon patch (black arrow). Photo: Sigurjon Orn Stefansson.

Fig. 4. The hole on the right heart was closed through a sternotomy performed in the emrgency room. Photo: Anna Sigurdardottir.

Fig. 5. When opening the pericardium it is important to do the opening parallell to the left phrenic nerve to prevent causing damage of the nerve. Drawing: Bergros Kristin Johannesdottir.