Extracorporeal Life Support in a Severe Blunt Chest Trauma with Cardiac Rupture

This report presents a case of severe blunt chest trauma secondary to a horse riding accident with resultant free-wall rupture of the left ventricle in association with severe lung contusion. We describe the initial surgical and medical management of the cardiac rupture which was associated with a massive haemoptysis due to severe lung trauma. Extra corporeal membrane oxygenation (ECMO) support was initiated and allowed both the acute heart and lung failure to recover. We discuss the successful use and pitfalls of ECMO techniques which are sparsely described in such severe combined cardiac and thoracic trauma. 1. Introduction Traumatic cardiac rupture rarely complicates blunt chest trauma but is almost always fatal due to sudden and massive bleeding. A rare proportion of victims who reach the hospital alive benefits from emergency cardiac surgery. However, heart rupture is often associated with severe heart failure in the postoperative period often resulting in death [1]. Extra corporeal life support (ECLS) has been utilized for the last 15 years, and its indications are now rapidly spreading [2]. With permission from our local Institutional Review Board, we are publishing an original case report of heart and lung traumatic injuries requiring urgent surgery and ECLS implantation during the surgical procedure and the postoperative course. 2. Case Report A 37-year-old woman was admitted to our emergency department for thoracic blunt trauma caused by chest trampling after a fall from a horse. Her medical history includes a Guillain-Barré syndrome without sequelae and a previous traumatic brain injury responsible of rare mnesic disorders. At the initial evaluation, the patient was conscious without any motor deficit. Clinical examination revealed severe hypoxia with pulse oximetry (SpO2) at 89% increasing to 98% breathing under O2 at 15？liters/min, a tachycardia of 120？bpm without hypotension (arterial blood pressure = 110/78？mmHg). The patient was complaining, however, of dorsal and left-sided chest pain. At admission, the respiratory status promptly deteriorated with increased hypoxemia. Initial chest X-ray revealed a left pneumothorax with bilateral lung contusions. Despite chest tube insertion, respiratory failure worsened, and trachea was intubated with immediate bradycardia, ventricular fibrillation, and finally asystole. Cardiopulmonary resuscitation with chest compression associated with intravenous (iv) adrenaline (total amount = 2.6？mg) was necessary for recovery of an effective circulatory activity. FAST-ultrasound scan identified pericardial