Sudden cardiac arrest due to blunt cardiac injury during multiple trauma care: A case report

Abstract text (incl. references and figure legends)

Case history: A 38 y.o. male was injured while he was driving a car and was administered the emergency room. He had no past medical history.

Clinical findings: He was treated by ATLS approach. Airway was open, respiratory rate was 38/min, SpO2 94% (oxygen mask 10L), heart rate was 82 beats/min, blood pressure was 67/35 mmHg, focused assessment with sonography for trauma (FAST) was negative, x-ray showed pelvic fracture, external bleeding was controlled. Glasgow Coma Scale was E3V4M5, and without hypothermia. The ECG showed normal sinus rhythm and right bundle branch block.

Investigation and diagnosis:

After extracellular fluid and blood transfusion therapies, he was performed with CT images.

Diagnosis: Bilateral rib and sternal fractures, liver injury, pelvic fracture, multiple fractures of the left lower leg.

Therapy and Progressions: Tracheal intubation was performed. After the intubation, his heart rate was suddenly dropped and went into cardiac arrest. He repeated pulseless electrical activity and return of spontaneous circulation. After starting Isoprenaline, the pulse rate stabilized. Further investigation revealed the complete atrioventricular block, temporally pacemaker (tPM) was implanted in emergency. The troponin level was high at admission, suggesting blunt cardiac injury. Echocardiography showed wall motion was normal and ejection fraction was 65% without pericardiac effusion. tPM was removed after 3 days. In 124 days, he was discharged from the hospital with crutches, without neurological symptoms.

Comments: Hemorrhage from injured extremities and arrhythmia by cardiac contusion led the severe hemodynamic instability. Previous reports showed difficulty in detecting blunt cardiac trauma in early phase in ER treatment. Careful assessment of arrythmia is crucial in cases of severe chest trauma.

Reference: Azade,et al: Air Med J. 2021: Myocardial Contusion: A Case of Fatal Cardiac Dysrhythmias During Air Medical Transportation.

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