Central Surgical Association| Volume 114, ISSUE 4, P788-793, October 1993

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Right ventricular response after myocardial contusion and hemorrhagic shock

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      Background. Prior functional studies on myocardial contusion (MC) have emphasized left ventricular performance even though the right ventricle (RV) is more likely to be injured after blunt trauma. Furthermore, associated injuries requiring resuscitation and surgery are frequently present. Our aim was to evaluate the impact of MC on RV function after MC and subsequent resuscitation from hemorrhagic shock.
      Methods. RV performance was evaluated with a modified pulmonary artery catheter that determines RV volumes and ejection fraction (RVEF), as well as filling pressures and cardiac output in an anesthetized swine model.
      Results. MC caused a 28% fall in mean arterial pressure and a 33% decrease in cardiac output. RVEF was 82%, and RV stroke work was 49% of baseline after injury. Resuscitation of hemorrhagic shock to baseline preload or greater failed to restore mean arterial pressure or cardiac output (depressed 23% and 22%, respectively). RV end-diastolic volume returned to baseline and central venous pressure was increased. RV dysfunction was depicted by a sustained depression of RV stroke work and RVEF.
      Conclusions. Impaired RV compliance and contractility, which was evident throughout this study, may hamper resuscitative efforts after multiple blunt trauma. RV monitoring may be useful in this setting.
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        • Tenzer ML
        The spectrum of myocardial contusion: a review.
        J Trauma. 1985; 25: 620-627
        • Mattox KL
        • Flint LM
        • Carrico CJ
        • et al.
        Blunt cardiac injury [Editorial].
        J Trauma. 1992; 33: 649-650
        • Fabian TC
        • Mangiante EC
        • Patterson CR
        • et al.
        Myocardial contusion in blunt trauma: clinical characteristics, means of diagnosis, and implications for patient management.
        J Trauma. 1988; 28: 50-57
        • Keller KD
        • Shatney CH
        Creatine phosphokinase-MB assays in patients with suspected myocardial contusion: diagnostic test or test of diagnosis.
        J Trauma. 1988; 28: 58-63
        • Stein PD
        • Sabbah HN
        • Viano DC
        • et al.
        Response of the heart to nonpenetrating cardiac trauma.
        J Trauma. 1982; 22: 364-373
        • Daper A
        • Parquier J
        • Preiser J
        • et al.
        Timing of cardiac output measurements during mechanical ventilation.
        Acute Care. 1986; 12: 113-116
        • Spinale FG
        • Smith AC
        • Corabello BA
        Right ventricular function computed by thermodilution and ventriculography.
        J Thorac Cardiovasc Surg. 1990; 99: 141-152
        • Baxter BT
        • Moore EE
        • Moore FA
        • et al.
        A plea for sensible management of myocardial contusion.
        Am J Surg. 1989; 158: 557-562
        • Snow N
        • Richardson JD
        • Flint LM
        Myocardial contusion: implications for patients with multiple traumatic injuries.
        Surgery. 1982; 92: 744-750
        • Healey MA
        • Brown R
        • Fleiszer D
        Blunt cardiac injury: is this diagnosis necessary?.
        J Trauma. 1990; 30: 137-146
        • Flancbaum L
        • Wright J
        • Siegel JH
        Emergency Surgery in patients with posttraumatic myocardial contusion.
        J Trauma. 1986; 26: 795-803
        • Doty DB
        • Anderson AE
        • Rose EF
        • et al.
        Cardiac trauma: clinical and experimental correlation of myocardial contusion.
        Ann Surg. 1974; 180: 452-460
        • Pomerantz M
        • Delgado F
        • Eiseman B
        Unsuspected depressed cardiac output following blunt thoracic or abdominal trauma.
        Surgery. 1971; 70: 865-871
        • Utley JR
        • Doty DB
        • Collins JC
        • et al.
        Cardiac output, coronary flow, ventricular fibrillation and survival following varying degrees of myocardial contusion.
        J Surg Res. 1976; 20: 539-543
        • Baxter BT
        • Moore EE
        • Synhorst DP
        • et al.
        Graded experimental myocardial contusion: impact on cardiac rhythm, coronary artery flow, ventricular function, and myocardial oxygen consumption.
        J Trauma. 1988; 28: 1411-1417
        • Torres-Mirabal P
        • Gruenberg JC
        • Brown RS
        • et al.
        Spectrum of myocardial contusion.
        Am Surg. 1982; 48: 383-392
        • DeGroot M
        • Prewitt RM
        Right ventricular contusion: experimental pathophysiology and treatment in an open-chest canine preparation.
        J Trauma. 1984; 24: 721-727
        • Sabbah HN
        • Stein PD
        • Hawkins ET
        • et al.
        Right ventricular outflow obstruction secondary to non-penetrating blunt trauma to the canine myocardium.
        J Trauma. 1982; 22: 1009-1014
        • Sutherland GR
        • Calvin JE
        • Driedger AA
        Anatomic and cardiopulmonary responses to trauma with associated blunt chest injury.
        J Trauma. 1981; 21: 1-11
        • Miller FB
        • Shumate CR
        • Richardson JD
        Myocardial contusion: when can the diagnosis be eliminated?.
        Arch Surg. 1989; 124: 805-808
        • Eisenach JC
        • Nugent M
        • Miller FA
        • et al.
        Echocardiographic evaluation of patients with blunt chest injury: correlation with perioperative hypotension.
        Anesthesiology. 1986; 64: 364-366