{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T22:30:45Z","timestamp":1790029845480,"version":"4.0.1"},"reference-count":16,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"unspecified","delay-in-days":82,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2026,6,5]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Penetrating cardiac trauma is associated with high mortality. Factors influencing survival remain incompletely characterized. This study aimed to identify injury patterns and presentation characteristics associated with survival after penetrating cardiac trauma at an urban, level 1 trauma center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective cohort study of patients with penetrating cardiac trauma identified from the hospital trauma registry between 2017 and 2025. Patients with documented penetrating cardiac injury were included. Demographic, physiological, and injury characteristics were compared between survivors and non-survivors using the Mann-Whitney U test for continuous variables and Pearson\u2019s \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      test or Fisher\u2019s test for categorical variables. Univariate Firth\u2019s logistic regression was used to calculate ORs with 95% CIs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 18\u2009041 trauma activations, 57 patients with penetrating cardiac injury were identified. Overall survival was 25%. Gunshot wound (GSW) was the most common mechanism of injury (67%) and was associated with a higher risk of mortality compared with stab wound injuries (SWIs) (OR 3.70, 95%\u2009CI 1.10 to 12.1). Multichamber cardiac injury (OR 10.9, 95%\u2009CI 1.26 to 1439), thoracic vascular injury (OR 12.3, 95%\u2009CI 1.43 to 1615), and concurrent abdominal injury (OR 4.40, 95%\u2009CI 1.12 to 24.7) were associated with death. Conversely, isolated cardiac injury (OR 0.21, 95%\u2009CI 0.06 to 0.75), spontaneous respirations (OR 0.06, 95%\u2009CI 0.01 to 0.24), and signs of life on presentation (OR 0.01, 95%\u2009CI 0 to 0.10) were predicted survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Penetrating cardiac trauma carries a high mortality rate. Survival was associated with SWI, preserved physiologic status on presentation, and injuries isolated to the heart, whereas GSW and concurrent thoracic vascular or abdominal injuries were associated with death. Recognition of these factors may assist clinicians in early triage and resuscitative decision-making.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Level of evidence<\/jats:italic>\n                      : level III, prognostic study.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tsaco-2026-002237","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:55:15Z","timestamp":1782140115000},"page":"e002237","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of survival after penetrating cardiac trauma: injury patterns and presentation factors"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9348-7708","authenticated-orcid":false,"given":"Michelle","family":"Mendiola Pla","sequence":"first","affiliation":[{"name":"Division of Trauma Surgery, Sinai Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5118-0556","authenticated-orcid":false,"given":"Jalia","family":"Anderson","sequence":"additional","affiliation":[{"name":"Division of Trauma Surgery, Sinai Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1700-091X","authenticated-orcid":false,"given":"Eliza","family":"Mundenmaney","sequence":"additional","affiliation":[{"name":"Division of Trauma Surgery, Sinai Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Trauma Surgery, Sinai Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3723-8565","authenticated-orcid":false,"given":"Holly","family":"Gui","sequence":"additional","affiliation":[{"name":"Division of Trauma Surgery, Sinai Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4607-4352","authenticated-orcid":false,"given":"Crystal","family":"Valdez","sequence":"additional","affiliation":[{"name":"Division of Trauma Surgery, Sinai Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1987-0888","authenticated-orcid":false,"given":"Grace","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Trauma Surgery, Sinai Chicago, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"2026062207550756000_11.2.e002237.1","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1177\/00031348241307400","article-title":"Cardiac Trauma: A Review of Penetrating and Blunt Cardiac Injuries","volume":"91","author":"Lee","year":"2025","journal-title":"Am Surg"},{"key":"2026062207550756000_11.2.e002237.2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2011.226"},{"key":"2026062207550756000_11.2.e002237.3","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/j.athoracsur.2019.12.038","article-title":"Ten-Year Trends in Traumatic Cardiac Injury and Outcomes: A Trauma Registry Analysis","volume":"110","author":"Tran","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2026062207550756000_11.2.e002237.4","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1016\/j.injury.2023.01.046","article-title":"Shot through the heart: A 17-year analysis of pre-hospital and hospital deaths from penetrating cardiac injuries","volume":"54","author":"McNicoll","year":"2023","journal-title":"Injury"},{"key":"2026062207550756000_11.2.e002237.5","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.athoracsur.2013.04.033","article-title":"Utilization of cardiothoracic surgeons for operative penetrating thoracic trauma and its impact on clinical outcomes","volume":"96","author":"Mollberg","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2026062207550756000_11.2.e002237.6","doi-asserted-by":"crossref","first-page":"S192","DOI":"10.21037\/jtd.2018.10.73","article-title":"Traumatic heart and great vessels injuries","volume":"11","author":"Barbero","year":"2019","journal-title":"J Thorac Dis"},{"key":"2026062207550756000_11.2.e002237.7","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2019.01952","article-title":"A Comparison of Phenotypic and Functional Properties of Mesenchymal Stromal Cells and Multipotent Adult Progenitor Cells","volume":"10","author":"Khan","year":"2019","journal-title":"Front Immunol"},{"key":"2026062207550756000_11.2.e002237.8","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2018-000201","article-title":"Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program","volume":"3","author":"Joseph","year":"2018","journal-title":"Trauma Surg Acute Care Open"},{"key":"2026062207550756000_11.2.e002237.9","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.008521"},{"key":"2026062207550756000_11.2.e002237.10","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/TA.0000000000004524","article-title":"Penetrating cardiac injuries: What you need to know","volume":"98","author":"Parreira","year":"2025","journal-title":"J Trauma Acute Care Surg"},{"key":"2026062207550756000_11.2.e002237.11","doi-asserted-by":"crossref","first-page":"e166","DOI":"10.1097\/TA.0000000000003753","article-title":"Treatment of penetrating cardiac wounds for the general surgeon on call","volume":"93","author":"Khaitan","year":"2022","journal-title":"J Trauma Acute Care Surg"},{"key":"2026062207550756000_11.2.e002237.12","doi-asserted-by":"publisher","DOI":"10.1016\/S1072-7515(97)00144-0"},{"key":"2026062207550756000_11.2.e002237.13","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/TA.0000000000001165","article-title":"Penetrating cardiac injuries: A 36-year perspective at an urban, Level I trauma center","volume":"81","author":"Morse","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"2026062207550756000_11.2.e002237.14","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1097\/TA.0000000000002808","article-title":"Penetrating injury to the cardiac box","volume":"89","author":"Kim","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"2026062207550756000_11.2.e002237.15","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/S0020-1383(97)00091-0","article-title":"Management of combined penetrating cardiac and abdominal trauma","volume":"28","author":"Saadia","year":"1997","journal-title":"Injury"},{"key":"2026062207550756000_11.2.e002237.16","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/TA.0000000000000648","article-title":"An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma","volume":"79","author":"Seamon","year":"2015","journal-title":"J Trauma Acute Care Surg"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2026-002237","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:55:17Z","timestamp":1782140117000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2026-002237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6,22]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/tsaco-2026-002237"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2026-002237","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}