Dados do Trabalho

Título

Successful Management of Severe Thoracic Trauma and ARDS with Prolonged ECMO Support: A Case of Multidisciplinary Intervention in a 29-Year-Old Motorcycle Accident Victim

Descrição do caso

Severe thoracic trauma often leads to life-threatening complications that require advanced interventions. FBSL, a previously healthy 29-year-old male, was involved in a motorcycle accident on March 30, colliding with a fixed object, resulting in an open bilateral chest injury. Initially treated at a local Emergency Care Unit (UPA), he was intubated and transferred to the Hospital das Clínicas of São Sebastião for pericardial suturing, lavage, and chest drainage. On the second day, he was transferred to the Hospital das Clínicas of the University of São Paulo Medical School (HC-FMUSP), intubated with a Glasgow Coma Scale (GCS) score of 6T, and placed on mechanical ventilation with 100% oxygen. A computed tomography (CT) scan revealed a parietoccipital hematoma, subcutaneous emphysema, bilateral pneumothorax, pneumopericardium, and left lung atelectasis. His condition worsened with refractory hypoxemia, acute respiratory distress syndrome (ARDS), and a PaO2/FiO2 ratio of 68. On the eighth day, veno-venous extracorporeal membrane oxygenation (ECMO) was initiated, leading to marked improvement in oxygenation and stability. Despite complications like distributive shock and acute kidney injury, ECMO support for 22 days was crucial in reversing severe hypoxemia. By the 21st day, thoracic reconstruction was performed, further aiding recovery. The patient was successfully weaned off ECMO on the 30th day, and his condition improved steadily thereafter. This case highlights the vital role of ECMO and multidisciplinary care in managing complex trauma with severe respiratory and renal complications, ultimately leading to a successful recovery.