Penetrating cardiac injury in children is a life-threatening emergency. The initial reaction of the witness and medical team management plays a crucial role in survival. We are reporting a five-year-old girl who had a penetrating cardiac injury after an accidental fall on a sharp date tree thorn, witnessed by her parents. They took their child immediately to the hospital without manipulating the thorn. The initial workup included an X-ray, echocardiography, and computed tomography (CT) of the chest, revealing that the thorn transfixed the heart from the anterior chest wall to the posterior mediastinum. The team controlled the child’s pain with analgesia and stabilized the vital signs awaiting transport to a cardiac center. In our center, the child was evaluated by a multidisciplinary team and then was taken to the OR. The surgical team extracted the thorn successfully on cardiopulmonary bypass and excluded any secondary injury. The child had an uneventful hospital course. 

Penetrating cardiac injuries by sharp objects from trees could happen to children. The outcome of cardiac injury depends on many factors, such as the extent of the injury, hemodynamic stability on arrival, and pericardial tamponade. The initial management, transportation by a skilled team, and planned surgical intervention are crucial to maintaining the patient’s life with penetrating cardiac injuries.

In conclusion, deep-seated penetrating cardiac injury in children is a potential cause of death. Early recognition, management, and surgical intervention are crucial for favorable outcomes.