Scholarlink

<p>A&#xa0;65-year-old woman was admitted to the emergency department following out-of-hospital cardiac arrest (OHCA) of unknown origin and successful resuscitation (CPR) on-scene. However, shortly after admission, the patient developed pericardial tamponade (PT) in the trauma bay despite an initially unremarkable echocardiography. Emergency pericardiocentesis was required to relieve the tamponade but led to hemorrhagic shock. Subsequent imaging and intraoperative findings revealed injury to the left circumflex artery (CX), likely caused by a&#xa0;left atrial appendage occluder (LAAO) that had penetrated the CX during resuscitation efforts. The tamponade was promptly identified through repeat extended focused assessment with sonography for trauma (eFAST) imaging following hemodynamic deterioration, and the underlying cause was quickly confirmed using standardized postresuscitation imaging protocols. The frequency of this complication remains unclear and warrants further investigation, particularly as the use of LAAOs continues to increase. These devices, while beneficial, may pose a&#xa0;risk for life-threatening, resuscitation-related injuries such as PT. This case report highlights the complexity of managing critically ill nontraumatic OHCA patients, who are often elderly, have multiple comorbidities, and may be on anticoagulation therapy—all factors that can complicate acute care. It also underscores the challenges of post-CPR management, as chest compressions themselves can cause significant trauma, even after brief durations of CPR. Common resuscitation-related injuries must therefore be anticipated and promptly addressed. Prehospital eFAST plays a&#xa0;critical role in the initial management of critically ill patients but should never delay transport. Repeating eFAST imaging after hospital admission is essential. In cases of hemodynamic deterioration, the ABCDE (airway, breathing, circulation, disability, and exposure) approach including eFAST sonography should be revisited, and differential diagnoses that were previously excluded must be reconsidered. To ensure high-quality care in these complex scenarios, the search for the underlying cause of OHCA should include standardized postresuscitation imaging as an integral part of trauma bay management.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Herausforderung im nichttraumatologischen Schockraum – Perikardtamponade durch Vorhofokkluder nach Reanimation

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年2月28日

查看全文
  • Susan Adel,
  • Hendrik Drinhaus,
  • Mattias Vollmer,
  • Volker Burst,
  • Christoph Adler,
  • Matthias Hackl

摘要

A 65-year-old woman was admitted to the emergency department following out-of-hospital cardiac arrest (OHCA) of unknown origin and successful resuscitation (CPR) on-scene. However, shortly after admission, the patient developed pericardial tamponade (PT) in the trauma bay despite an initially unremarkable echocardiography. Emergency pericardiocentesis was required to relieve the tamponade but led to hemorrhagic shock. Subsequent imaging and intraoperative findings revealed injury to the left circumflex artery (CX), likely caused by a left atrial appendage occluder (LAAO) that had penetrated the CX during resuscitation efforts. The tamponade was promptly identified through repeat extended focused assessment with sonography for trauma (eFAST) imaging following hemodynamic deterioration, and the underlying cause was quickly confirmed using standardized postresuscitation imaging protocols. The frequency of this complication remains unclear and warrants further investigation, particularly as the use of LAAOs continues to increase. These devices, while beneficial, may pose a risk for life-threatening, resuscitation-related injuries such as PT. This case report highlights the complexity of managing critically ill nontraumatic OHCA patients, who are often elderly, have multiple comorbidities, and may be on anticoagulation therapy—all factors that can complicate acute care. It also underscores the challenges of post-CPR management, as chest compressions themselves can cause significant trauma, even after brief durations of CPR. Common resuscitation-related injuries must therefore be anticipated and promptly addressed. Prehospital eFAST plays a critical role in the initial management of critically ill patients but should never delay transport. Repeating eFAST imaging after hospital admission is essential. In cases of hemodynamic deterioration, the ABCDE (airway, breathing, circulation, disability, and exposure) approach including eFAST sonography should be revisited, and differential diagnoses that were previously excluded must be reconsidered. To ensure high-quality care in these complex scenarios, the search for the underlying cause of OHCA should include standardized postresuscitation imaging as an integral part of trauma bay management.