Targeted temperature management (TTM) improves survival and neurological outcome after nontraumatic
cardiac arrest. However, TTM is not used widely after traumatic
cardiac arrest because of concerns that it might exacerbate
bleeding. We report the use of postarrest TTM after repair of blunt myocardial
rupture. A 48-year-old man was admitted after being rescued from a major traffic accident by the local emergency service. Focused sonography showed pericardial fluid without
cardiac tamponade. Computed tomography showed a large
hematoma in the anterior mediastinum associated with
hemopericardium. The patient developed
cardiac arrest during the operative preparations. Repeat bedside sonography revealed a large
pericardial effusion and signs of
cardiac tamponade. Spontaneous circulation was restored after ultrasound-guided pericardiocentesis. His Glasgow Coma Scale score was 3. The patient was transported promptly to the operating room and underwent
median sternotomy without
cardiopulmonary bypass. A
rupture of the junction of the superior vena cava/right atrium and left atrial appendage was detected and was closed by direct suturing. Immediately after return to the intensive care unit, we performed TTM (target body temperature 34.5°C) using a surface-cooling device at 4 hours postarrest. TTM was maintained for 24 hours and controlled gradual
rewarming was then initiated. He regained consciousness 36 hours postrewarming with limited speech ability. The patient recovered with no further
cardiac events and was discharged 3 weeks after admission, with no other serious complications. The patient was neurologically intact (cerebral performance category 1) at 6 months of follow-up. This case demonstrates the potential benefit and applicability of postarrest TTM in patients after repair of blunt myocardial
rupture.