The outcome of patients with penetrating heart injuries depends to a great extent on aggressive primary care and fast transport to the closest appropriate trauma center. There, after confirming the diagnosis, the injured victim has to be transferred without any delay to the operating room where the penetrating injury can be dealt with. The importance of resolute emergency management is shown based on a case presentation and a review of the current literature. The employment of extracorporal circulation (heart-lung machine) is rather subordinate in the primary care of these patients.