Abstract
Abstract Background: Blunt cardiac injury (BCI) is a rare, but life threatening injury. The treatment of BCI is surgical repair. However, in a BCI patient with hypothermia, acidosis, and coagulopathy, an attempt to control the bleeding completely by surgery alone may not be successful. Damage control principles should be used in this situation. Objective: To study a BCI patient who underwent a successful operation using damage control principles. Methods: We reviewed and analyzed the patient’s chart, operative notes and follow up visit records. Review of the literature regarding the issue was also conducted. Results: We report the case of a patient with BCI who developed hypothermia and coagulopathy during surgery. Abbreviated surgical repair was performed with a right pleuropericardial window created to avoid blood accumulation in the pericardial sac. Subsequent aggressive resuscitation was performed in the intensive care unit. We accepted ongoing bleeding through the right chest tubes while correction of hypothermia and coagulopathy was undertaken. The bleeding was gradually stopped once the patient’s physiology was restored. Although the patient developed a retained right hemothorax requiring subsequent video-assisted thoracoscopic surgery on the third postoperative week, he recovered uneventfully and was discharged on postoperative day 36. Conclusion: In patients with BCI who develop coagulopathy during surgery, terminating the operation quickly and creating a pleuropericardial window is a possible bailout solution because this can prevent postoperative cardiac tamponade without leaving the chest open. Continue bleeding from the chest tubes is acceptable provided that adequate resuscitation to correct coagulopathy is underway.
Highlights
Blunt cardiac injury (BCI) is a rare, but life threatening injury
We report a case in a patient with blunt cardiac rupture detected 24 hours after the injury who developed hypothermia and coagulopathy during a surgical repair
BCI is a rare injury for trauma surgeons, because most of the patients barely survive their accidents [2]
Summary
Supparerk Prichayudh, Kritaya Kritayakirana, Pasurachate Samorn, Rattaplee Pak-art, Sukanya Sriussadaporn, Suvit Sriussadaporn, Wilaiporn Kiatpadungkul, Kanthachat Thatsakorn, Ithiphon Viratanapanu Department of Surgery, Chulalongkorn University, Bangkok 10330, Thailand
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