First-Ever Emergency Department Thoracotomy For Post-Ablation Tamponade Reported
Minn. emergency physicians performed a thoracotomy on a patient whose heart was essentially drowning in its own blood
WASHINGTON-In a case reminiscent of the most dramatic episodes of the television show "ER," emergency physicians performed an emergency department thoracotomy on a patient whose heart was essentially drowning in its own blood, then kept her alive for 75 minutes until a surgeon and operating room became available.
The case, published online in Annals of Emergency Medicine, is the first of its kind reported in medical literature ("Modified Emergency Department Thoracotomy for Post-Ablation Cardiac Tamponade").
"She was dying in front of us and we had exhausted every option in standard procedures," said the lead study author Thomas E. Wyatt, MD, FACEP, of Mercy Medical Center in Coon Rapids, Minn. "Cracking someone's chest open is a go-for-broke move that is normally only performed on patients with penetrating trauma, like gunshot wounds or stabbings. Once we got her stabilized, we just kept her chest open, keeping her heart pumping, until the surgeon arrived. The patient had a good outcome and is doing well to this day."
The patient, a 42-year-old woman whose heart had recently been treated with ablation, a surgical procedure used to correct cardiac dysrhythmias, developed cardiac tamponade, a rare but known complication of ablation. The pericardium surrounding her heart filled with blood, preventing her heart from beating. She collapsed and went into shock. At a community hospital, physicians attempted to remove blood from the pericardial space with a long needle, but blood clots made it impossible. She went into cardiac arrest.
Dr. Wyatt opened the patient's chest and made a small incision in the pericardium in order to remove accumulated blood without risking the patient's bleeding to death or suffering permanent heart damage. He suctioned out blood clots and the patient's pulse returned to normal. For the next hour, Dr. Wyatt and emergency staff suctioned blood as it reaccumulated in the pericardium, transfused the patient with blood products and kept her stable until she could be transferred to surgery.
"Cardiac ablation procedures are on the rise and this case shows there may be a role for emergency department thoracotomy when traditional remedies for cardiac tamponade fail," said Dr. Wyatt. "Emergency physicians do what we have to do to save a life, even if it's unconventional. This patient had her chest open to the world for more than an hour, but she lived. My residency training made all the difference."
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.
