title: Successful Use of Targeted Temperature Management After Repair of Myocardial Rupture from Blunt Chest Trauma: A Case Report.
abstract: Targeted temperature management (TTM) improves survival and neurological outcome after nontraumatic cardiac arrest. However, TTM is not used widely after traumatic cardiac arrest because of concerns that it might exacerbate bleeding. We report the use of postarrest TTM after repair of blunt myocardial rupture. A 48-year-old man was admitted after being rescued from a major traffic accident by the local emergency service. Focused sonography showed pericardial fluid without cardiac tamponade. Computed tomography showed a large hematoma in the anterior mediastinum associated with hemopericardium. The patient developed cardiac arrest during the operative preparations. Repeat bedside sonography revealed a large pericardial effusion and signs of cardiac tamponade. Spontaneous circulation was restored after ultrasound-guided pericardiocentesis. His Glasgow Coma Scale score was 3. The patient was transported promptly to the operating room and underwent median sternotomy without cardiopulmonary bypass. A rupture of the junction of the superior vena cava/right atrium and left atrial appendage was detected and was closed by direct suturing. Immediately after return to the intensive care unit, we performed TTM (target body temperature 34.5°C) using a surface-cooling device at 4 hours postarrest. TTM was maintained for 24 hours and controlled gradual rewarming was then initiated. He regained consciousness 36 hours postrewarming with limited speech ability. The patient recovered with no further cardiac events and was discharged 3 weeks after admission, with no other serious complications. The patient was neurologically intact (cerebral performance category 1) at 6 months of follow-up. This case demonstrates the potential benefit and applicability of postarrest TTM in patients after repair of blunt myocardial rupture.
authors.affiliation: 1 Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital , Ulsan, Republic of Korea.
authors.forename: Wook-Jin
authors.initials: WJ
authors.lastname: Choi
authors.affiliation: 2 Department of Thoracic Surgery, University of Ulsan College of Medicine, Ulsan University Hospital , Ulsan, Republic of Korea.
authors.forename: Yun Seok
authors.initials: YS
authors.lastname: Kim
authors.affiliation: 1 Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital , Ulsan, Republic of Korea.
authors.forename: Jung Seok
authors.initials: JS
authors.lastname: Hong
authors.affiliation: 3 Department of Thoracic and Cardiovascular Surgery, Andong Hospital , Andong, Republic of Korea.
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Kim
mesh_terms: D000063:Accidents, Traffic; D001833:Body Temperature Regulation; D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: cardiac arrest; cardiovascular; emergency medicine; mild hypothermia