Extracorporeal
cardiopulmonary resuscitation (ECPR) followed by operating room
sternotomy, rather than resuscitative
thoracotomy, might be life-saving for patients with blunt
cardiac rupture and
cardiac arrest who do not have multiple severe traumatic
injuries. A 49-year-old man was injured in a vehicle crash and transferred to the emergency department. On admission, he was hemodynamically stable, but a plain chest radiograph revealed a widened mediastinum, and echocardiography revealed
hemopericardium. A computed tomography scan revealed
hemopericardium and mediastinal
hematoma, without other severe traumatic
injuries. However, the patient's pulse was lost soon after he was transferred to the intensive care unit, and
cardiopulmonary resuscitation was initiated. We initiated ECPR using femorofemoral veno-arterial
extracorporeal membrane oxygenation (ECMO) with
heparin administration, which achieved hemodynamic stability. He was transferred to the operating room for
sternotomy and cardiac repair. Right ventricular
rupture and pericardial sac
laceration were identified intraoperatively, and cardiac repair was performed. After repairing the
cardiac rupture, the cardiac output recovered spontaneously, and ECMO was discontinued intraoperatively. The patient recovered fully and was discharged from the hospital on postoperative day 7. In this patient, ECPR rapidly restored brain perfusion and provided enough time to perform operating room
sternotomy, allowing for good surgical exposure of the heart. Moreover, open
cardiac massage was unnecessary. ECPR with
sternotomy and cardiac repair is advisable for patients with blunt
cardiac rupture and
cardiac arrest who do not have severe multiple traumatic
injuries.