Extracorporeal cardiopulmonary resuscitation for blunt cardiac rupture
| Autor: | Keiji Tanaka, Kunihiko Okada, Shunsuke Kudo, Takahiro Takemura |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Cardiac output medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Hemopericardium 03 medical and health sciences 0302 clinical medicine Extracorporeal Membrane Oxygenation medicine Extracorporeal membrane oxygenation Humans Extracorporeal cardiopulmonary resuscitation Thoracotomy Cardiopulmonary resuscitation Cardiac Surgical Procedures Resuscitative thoracotomy business.industry Cardiac Rupture Accidents Traffic 030208 emergency & critical care medicine General Medicine Middle Aged Plastic Surgery Procedures medicine.disease Sternotomy Cardiopulmonary Resuscitation Surgery Myocardial Contusions Heart Injuries Anesthesia cardiovascular system Emergency Medicine Radiography Thoracic business Tomography X-Ray Computed |
| Zdroj: | The American journal of emergency medicine. 35(11) |
| ISSN: | 1532-8171 |
| Popis: | Extracorporeal cardiopulmonary resuscitation (ECPR) followed by operating room sternotomy, rather than resuscitative thoracotomy, might be life-saving for patients with blunt cardiac rupture and cardiac arrest who do not have multiple severe traumatic injuries. A 49-year-old man was injured in a vehicle crash and transferred to the emergency department. On admission, he was hemodynamically stable, but a plain chest radiograph revealed a widened mediastinum, and echocardiography revealed hemopericardium. A computed tomography scan revealed hemopericardium and mediastinal hematoma, without other severe traumatic injuries. However, the patient's pulse was lost soon after he was transferred to the intensive care unit, and cardiopulmonary resuscitation was initiated. We initiated ECPR using femorofemoral veno-arterial extracorporeal membrane oxygenation (ECMO) with heparin administration, which achieved hemodynamic stability. He was transferred to the operating room for sternotomy and cardiac repair. Right ventricular rupture and pericardial sac laceration were identified intraoperatively, and cardiac repair was performed. After repairing the cardiac rupture, the cardiac output recovered spontaneously, and ECMO was discontinued intraoperatively. The patient recovered fully and was discharged from the hospital on postoperative day 7. In this patient, ECPR rapidly restored brain perfusion and provided enough time to perform operating room sternotomy, allowing for good surgical exposure of the heart. Moreover, open cardiac massage was unnecessary. ECPR with sternotomy and cardiac repair is advisable for patients with blunt cardiac rupture and cardiac arrest who do not have severe multiple traumatic injuries. |
| Databáze: | OpenAIRE |
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