- 作者：Daniel W. Carlson ; MD ; MAJ MC USAF<sup>&lowast ; sup> ; Ryan D. Pearson ; MD ; Capt MC USAF<sup>&dagger ; sup> ; Paul F. Haggerty ; MD ; Capt MC USAF<sup>&Dagger ; sup> ; Richard J. Strilka ; MD ; Lt Col MC USAF<sup>§ ; sup> ; Benjamin S. Abella ; MD ; MPhil<sup>¡¬sup><sup> ; sup> ; Paul E. Gourley ; MD ; Col MC USAF<sup>¶ ; sup>
- 关键词：commotio cordis ; cardiac arrest ; therapeutic hypothermia ; cardiopulmonary resuscitation
- 刊名：Journal of Emergency Medicine
- 出版年：2013
- 出版时间：March, 2013
- 年：2013
- 卷：44
- 期：3
- 页码：620-624
- 全文大小：311 K
ss=""h4"">Background
Therapeutic hypothermia (TH) has been demonstrated to improve clinical outcomes after out-of-hospital ventricular fibrillation (VF) cardiac arrest. It remains unclear if TH can be safely and effectively used in the setting of traumatic arrest. Furthermore, the use of TH methods in the pre-hospital and transport environments remain poorly established and a domain of active investigation.ss=""h4"">Objectives
To describe a case of successful TH utilization after blunt trauma with commotio cordis and pulmonary contusion, and to describe the continuation of TH during international fixed-wing aeromedical transport.
ss=""h4"">Case Report
A 33-year-old active duty soldier suffered blunt chest trauma and immediate VF arrest. He was successfully resuscitated with cardiopulmonary resuscitation and defibrillation attempts. Given his ensuing comatose post-arrest state, he was therapeutically cooled and subsequently evacuated from Iraq to Germany, with cooling maintenance established in flight without the availability of training or commercial cooling equipment. The patient exhibited an eventual excellent neurologic recovery. To utilize TH for this patient, military physicians with limited local resources employed a telemedical approach to obtain a hypothermia protocol to develop a successful treatment plan.
ss=""h4"">Conclusions
The patient's successful resuscitation suggests that care should not be withheld for blunt trauma patients without vital signs in the field if VF is present, until the differential diagnosis of commotio cordis has been considered.