Cardiac Tamponade Associated with Blunt Cardiac Injury: Its Definitive Management in the Emergency Department
Author(s)
Tetsuya Yumoto1*,
Nao Umei1,
Yo Kinami1,
Hideo Yamanouchi1,
Keiji Sato1,
Yosuke Ueno2,
Yosuke Kuroko2,
Zenichi Masuda2,
Toyomu Ugawa1,
Yoshihito Ujike1
Affiliation(s)
1 Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan. 2 Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
1 Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan. 2 Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
ABSTRACT
Cardiac tamponade secondary to blunt cardiac injury is an extremely serious and life-threatening condition that the emergency physician is required to make definitive and appropriate management and resuscitation. Although blunt cardiac injury includes a wide spectrum of pathological conditions, cardiac tamponade due to blunt trauma is rarely seen because most of the patients with cardiac rupture die at the scene or before arrival at the hospital. Definitive surgical repair is commonly necessary following pericardial decompression if the patient is too unstable with impending cardiac arrest. Bringing the patient to definitive surgery as soon as possible is crucial for the chance of survival to the emergency physician. We describe two cases of cardiac tamponade resulting from blunt chest trauma successfully treated with a definitive management and surgical repair.
Cardiac tamponade secondary to blunt cardiac injury is an extremely serious and life-threatening condition that the emergency physician is required to make definitive and appropriate management and resuscitation. Although blunt cardiac injury includes a wide spectrum of pathological conditions, cardiac tamponade due to blunt trauma is rarely seen because most of the patients with cardiac rupture die at the scene or before arrival at the hospital. Definitive surgical repair is commonly necessary following pericardial decompression if the patient is too unstable with impending cardiac arrest. Bringing the patient to definitive surgery as soon as possible is crucial for the chance of survival to the emergency physician. We describe two cases of cardiac tamponade resulting from blunt chest trauma successfully treated with a definitive management and surgical repair.
Cite this paper
Yumoto, T. , Umei, N. , Kinami, Y. , Yamanouchi, H. , Sato, K. , Ueno, Y. , Kuroko, Y. , Masuda, Z. , Ugawa, T. and Ujike, Y. (2015) Cardiac Tamponade Associated with Blunt Cardiac Injury: Its Definitive Management in the Emergency Department. Open Journal of Emergency Medicine, 3, 9-12. doi: 10.4236/ojem.2015.32002.
Yumoto, T. , Umei, N. , Kinami, Y. , Yamanouchi, H. , Sato, K. , Ueno, Y. , Kuroko, Y. , Masuda, Z. , Ugawa, T. and Ujike, Y. (2015) Cardiac Tamponade Associated with Blunt Cardiac Injury: Its Definitive Management in the Emergency Department. Open Journal of Emergency Medicine, 3, 9-12. doi: 10.4236/ojem.2015.32002.
References
[1] Courcy, P.A., Stair, T.O. and Brotman, S. (1984) Subxiphoid Pericardial Window in Traumatic Pericardial Tamponade. The American Journal of Emergency Medicine, 2, 153-155.
http://dx.doi.org/10.1016/S0735-6757(84)80010-8 [2] Nan, Y.Y., Lu, MS., Liu, K.S., Huang, Y.K., Tsai, F.C., Chu, J.J. and Lin, P.J. (2009) Blunt Traumatic Cardiac Rupture: Therapeutic Options and Outcomes. Injury, 40, 938-945.
http://dx.doi.org/10.1016/j.injury.2009.05.016 [3] Lee, T.H., Ouellet, J.F., Cook, M., Schreiber, M.A. and Kortbeek, J.B. (2013) Pericardiocentesis in Trauma: A Systemic Review. The Journal of Trauma and Acute Care Surgery, 75, 543-549.
http://dx.doi.org/10.1097/TA.0b013e3182a1fea2 [4] Fulda, G., Brathwaite, C.E., Rodriguez, A., Turney S.Z., Dunham, C.M. and Cowley, R.A. (1991) Blunt Traumatic Rupture of the Heart and Pericardium: A Ten-Year Experience (1979-1989). The Journal of Trauma, 31, 167-172.
http://dx.doi.org/10.1097/00005373-199131020-00003 [5] Namai, A., Sakurai, M. and Fujiwara, H. (2007) Five Cases of Blunt Traumatic Cardiac Rupture: Success and Failure in Surgical Management. General Thoracic and Cardiovascular Surgery, 55, 200-204.
http://dx.doi.org/10.1007/s11748-007-0106-x [6] Pevec, W.C., Udekwu, A.O. and Peitzman, A.B. (1989) Blunt Rupture of the Myocardium. The Annals of Thoracic Surgery, 48, 139-142.
http://dx.doi.org/10.1016/0003-4975(89)90203-8 [7] Karalis, D.G., Victor, M.E., Davis, G.A., McAllister, M.P., Covalesky, V.A., Ross Jr., J.J., Foley, R.V., Kerstein, M.D. and Chandrasekaran, K. (1994) The Role of Echocardiography in Blunt Chest Trauma: A Transthoracic and Transesophageal Echocardiographic Study. The Journal of Trauma, 36, 53-58.
http://dx.doi.org/10.1097/00005373-199401000-00008 [8] Burlew, C.C., Moore, E.E., Moore, F.A., Coimbra, R., Mclntyre Jr., R.C., Davis, J.W., Sperry, J. and Biffl, W.L. (2012) Western Trauma Association Critical Decisions in Trauma: Resuscitative Thoracotomy. The Journal of Trauma and Acute Care Surgery, 73, 1359-1363.
http://dx.doi.org/10.1097/TA.0b013e318270d2df [9] Kurimoto, Y., Hase, M., Nara, S., Yama, N., Kawaharada, N., Morishita, K., Higami, T. and Asai, Y. (2006) Blind Subxiphoid Pericardiotomy for Cardiac Tamponade Because of Acute Hemopericardium. The Journal of Trauma, 61, 582-585.
http://dx.doi.org/10.1097/01.ta.0000236060.37952.ce [10] Fitzgerald, M., Spencer, J., Johnson, F., Marasco, S., Atkin, C. and Kossmann, T. (2005) Definitive Management of Acute Cardiac Tamponade Secondary to Blunt Trauma. Emergency Medicine Australasia, 17, 494-499.
http://dx.doi.org/10.1111/j.1742-6723.2005.00782.x
[1] Courcy, P.A., Stair, T.O. and Brotman, S. (1984) Subxiphoid Pericardial Window in Traumatic Pericardial Tamponade. The American Journal of Emergency Medicine, 2, 153-155.
http://dx.doi.org/10.1016/S0735-6757(84)80010-8 [2] Nan, Y.Y., Lu, MS., Liu, K.S., Huang, Y.K., Tsai, F.C., Chu, J.J. and Lin, P.J. (2009) Blunt Traumatic Cardiac Rupture: Therapeutic Options and Outcomes. Injury, 40, 938-945.
http://dx.doi.org/10.1016/j.injury.2009.05.016 [3] Lee, T.H., Ouellet, J.F., Cook, M., Schreiber, M.A. and Kortbeek, J.B. (2013) Pericardiocentesis in Trauma: A Systemic Review. The Journal of Trauma and Acute Care Surgery, 75, 543-549.
http://dx.doi.org/10.1097/TA.0b013e3182a1fea2 [4] Fulda, G., Brathwaite, C.E., Rodriguez, A., Turney S.Z., Dunham, C.M. and Cowley, R.A. (1991) Blunt Traumatic Rupture of the Heart and Pericardium: A Ten-Year Experience (1979-1989). The Journal of Trauma, 31, 167-172.
http://dx.doi.org/10.1097/00005373-199131020-00003 [5] Namai, A., Sakurai, M. and Fujiwara, H. (2007) Five Cases of Blunt Traumatic Cardiac Rupture: Success and Failure in Surgical Management. General Thoracic and Cardiovascular Surgery, 55, 200-204.
http://dx.doi.org/10.1007/s11748-007-0106-x [6] Pevec, W.C., Udekwu, A.O. and Peitzman, A.B. (1989) Blunt Rupture of the Myocardium. The Annals of Thoracic Surgery, 48, 139-142.
http://dx.doi.org/10.1016/0003-4975(89)90203-8 [7] Karalis, D.G., Victor, M.E., Davis, G.A., McAllister, M.P., Covalesky, V.A., Ross Jr., J.J., Foley, R.V., Kerstein, M.D. and Chandrasekaran, K. (1994) The Role of Echocardiography in Blunt Chest Trauma: A Transthoracic and Transesophageal Echocardiographic Study. The Journal of Trauma, 36, 53-58.
http://dx.doi.org/10.1097/00005373-199401000-00008 [8] Burlew, C.C., Moore, E.E., Moore, F.A., Coimbra, R., Mclntyre Jr., R.C., Davis, J.W., Sperry, J. and Biffl, W.L. (2012) Western Trauma Association Critical Decisions in Trauma: Resuscitative Thoracotomy. The Journal of Trauma and Acute Care Surgery, 73, 1359-1363.
http://dx.doi.org/10.1097/TA.0b013e318270d2df [9] Kurimoto, Y., Hase, M., Nara, S., Yama, N., Kawaharada, N., Morishita, K., Higami, T. and Asai, Y. (2006) Blind Subxiphoid Pericardiotomy for Cardiac Tamponade Because of Acute Hemopericardium. The Journal of Trauma, 61, 582-585.
http://dx.doi.org/10.1097/01.ta.0000236060.37952.ce [10] Fitzgerald, M., Spencer, J., Johnson, F., Marasco, S., Atkin, C. and Kossmann, T. (2005) Definitive Management of Acute Cardiac Tamponade Secondary to Blunt Trauma. Emergency Medicine Australasia, 17, 494-499.
http://dx.doi.org/10.1111/j.1742-6723.2005.00782.x