A case of cardiac impalement injury with severe shock treated surgically after diagnosis using computed tomography and managed via extracorporeal membrane oxygenation in the hybrid emergency room

Abstract

The Hybrid Emergency Room System (HERS) allows clinicians to perform life-saving procedures without having to transfer patients. Several studies have reported the effectiveness of the HERS in the treatment of blunt trauma patients. However, the use of a hybrid emergency room (ER) for the treatment of penetrating cardiac injuries, including impalement injuries, has not been reported. We present the case of a patient with cardiac impalement injury that was diagnosed via computed tomography (CT) and was managed via extracorporeal membrane oxygenation (ECMO) in the hybrid ER and via surgery in the operating room. A 55-year-old man was transferred to our hybrid ER due to a penetrating wood injury through the right thoracic region. The patient had unstable vital signs. A CT scan revealed a pericardial effusion, right lung contusion, and bilateral pneumothoraxes. There were no signs of hemothorax or aortic injury. Veno-arterial-ECMO was performed in preparation for surgery. The patient was then transferred to the operating room. Pericardiotomy and cardiac repair were performed, and the ECMO was discontinued postoperatively. The patient was discharged on postoperative day 10 without complications. The hybrid ER allows rapid CT examination without relocation. Thus, it facilitates the formation of a timely and effective treatment plan. This report documents the successful management of a cardiac impalement injury in the HERS.

Keywords

• Impalement
• Cardiac injury
• Hybrid emergency room
• Extracorporeal membrane oxygenation