Authors
Solovyev I.A.1, 2, 3, Polikarpova E.V.1, Andreenko A.A.1, 3, Glebova A.V.1, 2, Zakirov A.I.1, Pavelts M.K.1, 2, Ouni K.2, Kosmakov I.A.1, 2
1 State Budgetary Healthcare Institution “City Mariinskaya Hospital”, St. Petersburg
2 St. Petersburg State Pediatric Medical University, St. Petersburg
3 S.M. Kirov Military medical academy, St. Petersburg
Abstract
Relevance. Resuscitative thoracotomy remains a controversial procedure in civilian multidisciplinary hospitals due to low survival rates with indiscriminate use and limited experience among surgical teams. However, for penetrating chest injuries with traumatic cardiac arrest, timely RT can achieve survival rates of 15–35%.
Aim. Resuscitative thoracotomy is an effective intervention for massive hemorrhage and traumatic cardiac arrest in a multidisciplinary hospital setting.
Case Description. We report a clinical case. Patient В., a 27-year-old male, was admitted 30 minutes after sustaining a stab-incised wound to the left chest. On admission: BP 65/46 mm Hg, HR 146 bpm, MFS-CA (Military Field Surgery – Condition on Admission) 43 points, subtotal left hemothorax per eFAST (extended Focused assessment with sonography in trauma). Indications for emergent thoracotomy were established. Bulau drainage was performed, and the patient was transferred to the operating room (15 minutes post-admission). Traumatic circulatory arrest developed during transfer to the operating table. Resuscitative thoracotomy was performed via left 5th intercostal space. The bleeding source was a completely transected left internal mammary artery. Interventions included aortic cross-clamping, direct cardiac massage, artery ligation, and suturing of the S4 segment wound in the upper lobe of the left lung. Spontaneous circulation was restored 13 minutes after aortic clamping. Total blood loss was 3500 mL. The patient was discharged on day 22 in satisfactory condition without neurological deficit.
Conclusion. This case demonstrates the effectiveness of the resuscitative thoracotomy protocol in a multidisciplinary hospital when strict temporal criteria and interdisciplinary coordination are adhered to.
Keywords: resuscitative thoracotomy, stab-incised chest wound, traumatic cardiac arrest, hemothorax, internal mammary artery, hemorrhagic shock, multidisciplinary hospital.
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