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Syrian War Penetrating Cardiac Injuries in Two Aleppo Hospitals

Mahmoud Hariri, Abdul Muti Aswad, Mohamed El Edrees, Yasser Abo Khamis, Hussam Aldien Dubies, Ahmed Osama, Timothy B Erickson

Background: During conflict situations and war, penetrating cardiac injury (PCI) is a universally life threatening condition with a low survivability rate. A large majority of victims do not make it to the hospital and expire at the scene. Those that do survive are often in extremis and shock upon arrival to the hospital. These traumatic injuries require rapid intervention and aggressive patient stabilization. Early operative intervention is the key element to survival. Methods: We retrospectively describe 11 patients with PCI in two low resource field hospitals in Aleppo during the Syrian War over an 18-month period from December 2013 through May 2015. Data was collected retrospectively from patient records as well as available documents and diagnostic studies. Inclusion criteria were all patients with penetrating cardiac injury who arrived to the emergency department, were resuscitated, and subsequently taken to the operating theater. Results: Syrian surgeons were optimally aided by diagnostic bedside FAST ultrasonography. Ten of eleven patients described in our series survived with life-saving operative interventions featuring thoracotomies, rapid bleeding source identification and repair, with postoperative surgical intensive care monitoring. Conclusions: Training out of necessity and intense field experience for general surgeons during the Syrian war proved effective in rescuing patients with PCI who may have otherwise not survived.