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VA-ECMO as a salvage strategy for blunt cardiac injury in the context of multisystem trauma
  1. Gary Peter Misselbrook1,2,
  2. S Morad Hameed1,3,
  3. Naisan Garraway1,3 and
  4. Rihab Al-Lawati3
  1. 1Division of Critical Care, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  2. 2School of Anaesthesia and Intensive Care Medicine, Health Education England Wessex, Winchester, Hampshire, UK
  3. 3Trauma and Acute Care Surgery, Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Gary Peter Misselbrook; garymisselbrook{at}doctors.org.uk

Abstract

A 47-year-old man sustained multisystem injuries after being struck by a vehicle travelling at high speeds. Shortly after admission to the emergency department he suffered a ventricular tachycardia/ventricular fibrillation cardiac arrest lasting 30 min. Investigations following return of spontaneous circulation raised suspicion for an anterolateral ST-elevation myocardial infarction. Despite his major traumatic injuries the patient was transferred for percutaneous coronary intervention uncovering a complete thrombosis of the ostium of the left anterior descending artery. Immediately following coronary revascularisation, the patient developed cardiogenic shock resulting in a multidisciplinary decision to place the patient on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The management of cardiogenic shock due to acute myocardial infarction with VA-ECMO and multiple traumatic injuries were often at odds with each other, resulting in a series of challenging decisions on timing of surgery and anticoagulation. The patient was liberated from VA-ECMO after 72 hours and continues rehabilitation in hospital.

  • trauma
  • interventional cardiology
  • resuscitation
  • adult intensive care
  • cardiothoracic surgery

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Footnotes

  • Twitter @IntenseMedic

  • Contributors GPM involved in care of patient, writing of manuscript. SMH and NG involved in review of manuscript. All authors, including RAL are involved in delivery of patient’s care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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