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Commotio Cordis, Therapeutic Hypothermia, and Evacuation from a United States Military Base in Iraq

Published on Mar 1, 2013in Journal of Emergency Medicine1.247
路 DOI :10.1016/j.jemermed.2012.08.014
Daniel W. Carlson3
Estimated H-index: 3
(WRGH: Walter Reed Army Medical Center),
Ryan D. Pearson1
Estimated H-index: 1
+ 3 AuthorsPaul E. Gourley1
Estimated H-index: 1
Sources
Abstract
Abstract 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. 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. 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. 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.
  • References (15)
  • Citations (3)
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References15
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#1Mary Ann PeberdyH-Index: 46
#2Clifton W. CallawayH-Index: 61
Last. Steven L. KronickH-Index: 14
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There is increasing recognition that systematic post鈥揷ardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good quality of life. This is based in part on the publication of results of randomized controlled clinical trials as well as a description of the post鈥揷ardiac arrest syndrome. 1鈥3 Post鈥揷ardiac arrest care has significant potential to reduce early mortality caused by hemodynamic instability and later morbidity and mortality fr...
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#1Chun Chieh Yeh (PRC: China Medical University (PRC))H-Index: 16
#2Chi Hsun Hsieh (PRC: China Medical University (PRC))H-Index: 13
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It is futile to attempt resuscitation in a blunt injury patient with no vital signs upon arriving at the emergency department. Therefore, it is recommended that resuscitation be withheld in any blunt trauma patient without vital signs while emergency medical technicians arrive at the scene of the accident. This report presents a case of a blunt torso trauma patient who lost vital signs at the scene and still received cardiopulmonary resuscitation until recovery of spontaneous circulation at the ...
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tance, impaired drug clearance, and mild coagulopathy. Targeted interventions are required to effectively manage these side effects. Hypothermia does not decrease myocardial contractility or induce hypotension if hypovolemia is corrected, and preliminary evidence suggests that it can be safely used in patients with cardiac shock. Cardiac output will decrease due to hypothermiainduced bradycardia, but given that metabolic rate also decreases the balance between supply and demand, is usually maint...
640 CitationsSource
#1Emily SagalynH-Index: 1
#2Roger A. BandH-Index: 13
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Objectives:We sought to review findings from recent literature on the postresuscitation care of cardiac arrest patients using therapeutic hypothermia as part of nontrial treatment.Design:Literature review.Setting:Hospital-based environment.Subjects:Patients initially resuscitated from cardiac arrest
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Abstract Improving survival and brain function after initial resuscitation from cardiac arrest remains a critical challenge with few therapeutic options. The publication of several randomized controlled trials supporting the use of therapeutic hypothermia in cardiac arrest survivors has provided a remarkable opportunity to reduce mortality and neurologic disability from this leading cause of death. On the strength of these trials, therapeutic hypothermia has now been incorporated in the American...
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#1James Tibballs (Royal Children's Hospital)H-Index: 38
#2Timothy Thiruchelvam (Royal Children's Hospital)H-Index: 1
Summary Commotio cordis or ventricular fibrillation caused by a blow to the chest is a rare cause of cardiac arrest in a well child. We report a case of a young child falling from a low height landing chest first with rapid onset of unconsciousness, apnoea and cyanosis. Cardiopulmonary resuscitation was given by parents under telephone instruction from an ambulance dispatch centre. On arrival of officers, 7min after the fall, ventricular fibrillation was present but responded to defibrillation (...
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#1Christopher Madias (Tufts Medical Center)H-Index: 2
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Commotio cordis (CC), sudden death as a result of a blunt, often innocent-appearing chest wall blow, is being reported with increasing frequency. The clinical spectrum is diverse; however, a substantial number of cases occur in youth athletics. In events that occur during sport, victims are struck by projectiles regarded as standard implements of the game. Sudden death is instantaneous and victims are most often found in ventricular fibrillation (VF). Overall survival is poor; however, successfu...
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Sudden and unexpected deaths of young athletes are most frequently the consequence of unsuspected cardiovascular diseases ([1][1]). However, participants in organized sports are also subject to another risk for sudden death that occurs in the absence of cardiovascular disease鈥攏amely, blunt, non-
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#1Robert E. Eckart (Harvard University)H-Index: 1
Last. Renu VirmaniH-Index: 141
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Background: Sudden death among military recruits is a rare but devastating occurrence. Because extensive medical data are available on this cross-sectional and diverse population, identification of the underlying causes of sudden death may promote health care policy to reduce the incidence of sudden death. Objective: To determine the causes of nontraumatic sudden death among a cohort of military recruits. Design: Retrospective cohort study using demographic and au topsy data from the Department ...
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#1Maximilian Mulder (Abbott Northwestern Hospital)H-Index: 7
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Abstract This chapter aims to provide an up-to-date review of the science and clinical practice pertaining to neurologic injury after successful cardiopulmonary resuscitation. The past two decades have seen a major shift in the science and practice of cardiopulmonary resuscitation, with a major emphasis on postresuscitation neurologic care. This chapter provides a nuanced and thoughtful historic and bench-to-bedside overview of the neurologic aspects of cardiopulmonary resuscitation. A particula...
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#1Daniel Howes (Queen's University)H-Index: 13
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Abstract Sudden cardiac death is a major health problem and a recurring issue in forensic medicine. Most cases are attributed to congenital heart disease, cardiomyopathy, myocarditis, pathology of the coronary arteries, long or short QT interval syndromes, Brugada syndrome or secondary toxic effects of cardioactive drugs. Sudden death caused by Commotio cordis after an accidental fall is very rare in women. Victims are essentially young people who die following a direct blow to the chest sustain...
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