Abstract
Background: Blunt trauma to the chest may cause respiratory-related severe disease because of the presence of vital organs such as the heart and lungs.
Case: A man in his 20s jumped from the roof of a five-story building and was transported to the hospital by ambulance. On arrival, he was in shock, with pulmonary contusion; left pulmonary artery injury and hemorrhage; left iliopsoas hematoma; burst fracture of the thoracolumbar spine; fractures of the right scapula, left clavicle, and first rib; and open fractures of the left tibia and fibula. Because of significant left pulmonary contusion and airway hemorrhage, isolated pulmonary ventilation was necessary, and selective embolization of the left upper lobe and lingular pulmonary artery was performed. Respiratory failure progressed after admission to the ICU. As there was possibility of injury to the inferior vena cava, a 27F double lumen catheter (DLC) was inserted from the right internal jugular vein and veno-venous extracorporeal membrane oxygenation (V-V ECMO) was performed without anticoagulant therapy. However, right severe pneumothorax appeared immediately after, which temporarily led to complete dependence on ECMO. On the 5th hospital day, the patient showed gradual improvement in oxygenation and was weaned from ECMO. The patient was discharged on the 31st hospital day.
Discussion and conclusion: The present patient was initially treated with isolated pulmonary ventilation and vascular embolization for traumatic respiratory failure; however, due to manifestation of contralateral lung injury, oxygenation ability decreased markedly, so we performed V-V ECMO with DLC. To the best of our knowledge, this is the first case in Japan in which separate lung ventilation and ECMO using DLC have been used in combination for the treatment of respiratory failure due to chest trauma. Our findings suggest that intensive care that includes ECMO should be considered for severe respiratory failure due to chest trauma.
