Penetrating cardiac injury repaired under "intentional cardiac arrest" with adenosine triphosphate

Kazuki Hagiwara; Jun-Ichi Inoue; Gaku Matumoto; Fumiaki Iwase

doi:10.1002/ams2.686

Penetrating cardiac injury repaired under "intentional cardiac arrest" with adenosine triphosphate

Acute Med Surg. 2021 Aug 7;8(1):e686. doi: 10.1002/ams2.686. eCollection 2021 Jan-Dec.

Authors

Kazuki Hagiwara^{1

2}, Jun-Ichi Inoue^{1

2}, Gaku Matumoto^{1

2}, Fumiaki Iwase^{1

2}

Affiliations

¹ Department of Advanced Emergency and Critical Care Medical Center Yamanashi Prefectural Central Hospital Kofu City Yamanashi Prefecture Japan.
² Department of Advanced Emergency and Critical Care Medicine Nippon Medical School Bunkyo-Ku Tokyo Japan.

Abstract

Background: Repairing a cardiac injury with beating heart is sometimes difficult and is associated with increased risks of complications. Here we report a case of cardiac injury repaired with administration of adenosine triphosphate (ATP).

Case presentation: A 46-year-old man was stabbed in his chest with a knife and transferred to our hospital. He was hemodynamically unstable, and echocardiography showed pericardial effusion. Emergency thoracotomy revealed a full-thickness injury in the right ventricle next to the coronary artery. He went into cardiac arrest and was resuscitated with adrenaline administration. We tried to suture immediately, but it was difficult because of tachycardia. After administering 20 mg of ATP (80 mg in total over 15 min), bradycardia was induced that led to "intentional cardiac arrest" after which suturing was performed. He was discharged on the 13th day without complications.

Conclusion: Cases of penetrating cardiac injury repaired using ATP are rare. Administration of ATP may be a useful option while repairing cardiac injuries.

Keywords: Adenosine triphosphate; cardiac rupture; thoracotomy; trauma.

Publication types

Case Reports