MMSL 2019, 88(3):134-138 | DOI: 10.31482/mmsl.2019.012

SUCCESSFUL EMERGENCY THORACOTOMY FOR BLAST INJURY: A CASE REPORTCase report

Radek Pohnán ORCID...1,2*, Vladislav Hytych2, Radek Doležel1
1 Chirurgická klinika 2.LF UK a ÚVN, Praha
2 Oddělení hrudní chirurgie, Thomayerova nemocnice, Praha

Jednou z hlavních příčin úmrtí ve válečných konfliktech je krvácení. Pacienti vyžadující kardiopulmonální resuscitaci po moribundním poranění mají velmi nepříznivou prognózu. Determinantem přežití u kriticky zraněných je doba do chirurgického zásahu. Resuscitativní emergentní torakotomie je život zachraňující  léčebný výkon u vybraných poraněných v hemoragickém šoku se zástavou oběhu.
V tomto sdělení je prezentován případ úspěšného použití emergentní torakotomie u těžce zraněného spojeneckého vojáka s hemoragickým šokem a srdeční zástavou po výbuchu sebevražedného atentátníka.
Rychlá diagnóza a bezodkladná emergentní torakotomie jsou v indikovaných případech efektivní léčebnou metodou pro pacienty s těžkým traumatem hrudníku či břicha.

Keywords: polytrauma; otevřená kardiopulmonální resuscitace; emergentní torakotomie; blast poranění

Exsanguination is one of the leading causes of death in a battlefield. Patients who require cardiopulmonary resuscitation after moribund trauma have an unfavorable prognosis. The determinant of survival in critically injured is a time to surgical intervention. Resuscitative emergency thoracotomy may be the lifesaving treatment in selected patients with trunk trauma and cardiac arrest after hemorrhagic shock.This is a case report of successfully applied resuscitative surgical techniques in severely injured allied soldier with hemorrhagic shock and cardiac arrest after suicide bomber explosion. A prompt diagnosis and a rapid emergency thoracotomy are lifesaving in moribund penetrating or blunt trunk trauma.

Keywords: polytrauma; open cardiopulmonary resuscitation; emergency thoracotomy; blast injury

Received: April 7, 2019; Accepted: May 17, 2019; Prepublished online: July 17, 2019; Published: September 6, 2019  Show citation

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Pohnán, R., Hytych, V., & Doležel, R. (2019). SUCCESSFUL EMERGENCY THORACOTOMY FOR BLAST INJURY: A CASE REPORT. MMSL, 88(3), 134-138. doi: 10.31482/mmsl.2019.012
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    References

    1. Siram S, Oyetunji T, Johnson SM, et al.. Predictors for Survival of Penetrating Trauma Using Emergency Department Thoracotomy in an Urban Trauma Center: The Cardiac Instability Score, Journal of the National Medical Association, J Natl Med Assoc. 2010;102:126-130. Go to original source... Go to PubMed...
    2. Vallejo-Manzur F, Varon J, Fromm R Jr, et al.. Moritz Schiff and the history of open-chest cardiac massage. Resuscitation. 2002;53:3-5. Go to original source... Go to PubMed...
    3. Strømskag KE. Kristian Igelsrud and the first successful direct heart compression. Tidsskr Nor Laegeforen. 2002;122:2863-2865. Go to PubMed...
    4. Kornhall DK, Dolven T. Resuscitative thoracotomies and open chest cardiac compressions in non-traumatic cardiac arrest. WJES. 2014;9:54. Go to original source... Go to PubMed...
    5. Beall AC Jr, Ochsner JL, Morris GC Jr, et al., Penetrating wounds of the heart. J Trauma. 1961;1:195-207. Go to original source... Go to PubMed...
    6. Beall AC Jr, Morris GC Jr, Cooley DA. Temporary cardiopulmonary bypass in the management of penetrating wounds of the heart. Surgery. 1962;52:330-337. Go to PubMed...
    7. Gretchen SL, Neel K. Emergency Bedside Thoracotomy. Available on https://emedicine.medscape.com/article/82584-overview
    8. Pohnán R, Hytych V. Emergentní thorakotomie. In: Hytych V, Tašková A, a kol. Traumatologie hrudníku v instruktivních kazuistikách. 1.vyd. Praha: Maxdorf; 2017; 234-236.
    9. Kotwal RS, Montgomery HR, Kotwal BM, et al. Eliminating preventable death on the battlefield. Arch Surg. 2011;146:1350-1358. Go to original source... Go to PubMed...
    10. Eastridge BJ, Mabry RL, Seguin P, et al..Death on the battlefield (2001-2011): Implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73:431-437. Go to original source... Go to PubMed...
    11. Pust GD, Namias N. Resuscitative thoracotomy. Int J Surg. 2016;33:202-208. Go to original source... Go to PubMed...
    12. Seamon MJ, Haut ER, Van Arendonk K, et al.. An evidence-based approach to patient selection for emergency department thoracotomy: a practice management guideline from the Eastern Association for the Surgery of Trauma, J. Trauma Acute Care Surg. 2015;79:159-173. Go to original source... Go to PubMed...
    13. Seamon MJ, Fisher CA, Gaughan JP, et al. Emergency Department Thoracotomy: Survival of the Least Expected. World J. Surg 2008;32:604-612. Go to original source... Go to PubMed...
    14. Smejkal K, Parizková R, Lochman P. Successful Urgent Thoracotomy in a Patient with Penetrating Heart Injury - Case Report. Acta Chir. Orthop. Traum. Cech, 2010;77:247 - 249. Go to original source...
    15. Pohnan R, Ryska M, Hytych V, et al. Echinococcosis mimicking liver malignancy: A case report. Int J Surg Case Rep. 2017;36:55-58. doi: 10.1016/j.ijscr.2017.04.032. Go to original source... Go to PubMed...
    16. Hytych V, Horazdovsky P, Pohnan R, et al. VATS lobectomy, history, indication, contraindication and general techniques. Bratisl Lek Listy. 2015;116:400-403. doi:10.4149/BLL_2015_076 Go to original source... Go to PubMed...
    17. Hytych V, Horazdovsky P, Stehlik L, et al. Our own method of fixation of biodegradable tracheal stent. Bratisl Lek Listy. 2015;116:340-342. doi:10.4149/BLL_2015_064 Go to original source... Go to PubMed...
    18. Hytych V, Pohnan R, Taskova A, et al. Importance of histological verification of mediastinal lymphadenopathy in exact staging of non-small cell bronchogenic carcinoma. Bratisl Lek Listy. 2014;115:585-587. doi:10.4149/BLL_2014_113 Go to original source... Go to PubMed...
    19. Petrone P, Asensio JA. Surgical management of penetrating pulmonary injuries. Scand J Trauma Resusc Emerg Med. 2009;17:8. doi:10.1186/1757-7241-17-8 Go to original source... Go to PubMed...
    20. Asensio JA, Petrone P, O'Shanahan G, Kuncir EJ. Managing exsanguination: what we know about damage control/bailout is not enough. Proc (Bayl Univ Med Cent). 2003;16(3):294-296. Go to original source... Go to PubMed...
    21. Asensio JA, Arroyo H, Veloz W. et al. Penetrating thoracoabdominal injuries: Ongoing dilemma-Which cavity and when? World J. Surg. 2002;26:539. https://doi.org/10.1007/s00268-001-0147-8 Go to original source... Go to PubMed...

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