Citation Information :
Rapoport M, Rose ND, Ibrahim MK, Bar-Haim R, Klein Y, Nugzar R, Soroksky A, Yakubovitch D, Goldstein AL. A Case Report of Blunt Aortic Trauma in a Difficult Anatomic Location with Emergent Intraoperating Room Extracorporeal Membrane Oxygenation. Panam J Trauma Crit Care Emerg Surg 2024; 13 (1):57-61.
Aim and background: To describe the challenges of a multitrauma patient with severe blunt chest trauma, including thoracic aortic injury, and the need for emergent extracorporeal membrane oxygenation (ECMO) in the operating room.
Case description: A young man was involved in a high-speed motorcycle accident with his chest reportedly hitting the curb. In the trauma bay, he was unstable, with a positive abdominal focused assessment with sonography for trauma (FAST), and a chest X-ray (CXR) with a widened mediastinum. He underwent emergent damage control abdominal surgery, followed by a total body computed tomography (CT), and definitive endovascular repair of a proximal descending thoracic aortic injury with carotid-carotid-left subclavian bypass graft. During the first 36 hours, he received ultramassive blood product transfusion and emergent venovenous (VV) ECMO placement in the operating room. Despite his survival, he suffered from partial paralysis and infection of the vascular bypass graft.
Conclusion: Thoracic aortic injury in the multitrauma patient remains a challenge. The use of ECMO in the acute setting has life-saving potential. Multidisciplinary teams optimize the outcome of these difficult patients.
Clinical significance: Here, we show examples of a supine trauma bay CXR that was sensitive for aortic injury, the complexity of blunt thoracic aortic trauma definitive care, and utilization of emergent ECMO.
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