Penetrating Nail-Gun Injury of the Heart Managed by Adenosine-Induced Asystole in the Absence of a Heart-Lung Machine

Abstract

During his work, an 18-year-old carpenter-in-training overbalanced and shot himself in the left median thorax with a nail gun. The patient was delivered to our thoracic surgery unit with a tentative diagnosis of penetrating lung trauma. An emergent computed tomogram showed a heart-penetrating nail injury. The patient was taken to the operating room, where he underwent emergency surgery that included sternotomy, pericardiotomy, extraction of the nail, and trauma treatment of the heart injury. The surgery was performed in a unit without a heart-lung machine. For that reason, asystole was chemically induced by the intravenous administration of adenosine. The surgery was successful, and the patient was discharged from the hospital on the 10th postoperative day. In cases of penetrating injuries of the heart, especially those with a foreign body retained in situ, we believe that the intravenous administration of adenosine is an elegant solution for the rapid provocation of asystole. In contrast to other methods, adenosine-induced asystole enables relatively safe myocardial manipulation in the absence of a cardiac surgical unit and a heart-lung machine.

Delayed Cardiac Rupture Induced by Traumatic Myocardial Infarction: Consequence of a 45-Magnum Blast Injury; A Comprehensive Case Review

“…can lead to an extension of the defect or to an accidental closure of a coronary artery. In two of our other cases with penetrating cardiac trauma, the heart could be shut down with a bolus-injection of adenosine to achieve a safe primary closure [26,27]. In our current case the injection of adenosine did not lead to the desired reaction.…”

“…In our current case the injection of adenosine did not lead to the desired reaction. In special cardiac injury patterns the bolus-injection of adenosine is a therapeutic option [26][27][28][29]. Alternatively, a Forgatyor a Foley-catheter can be placed for temporary defect occlusion [30][31][32][33][34].…”

The Protective Effect of Adenosine-Preconditioning on Paraquat-Induced Damage inCaenorhabditis elegans

“…For example, adenosine could decrease the superoxide anion produced by polymorphonuclear leukocytes (PMNs) through the adenosine A2 receptor. 22 Adenosine signaling based on adenosine receptor induced by Caffeine could partially extend the life span of C. elegans. 23 Similarly, Peralta et al 24 reported that the protective effect of adenosine could be a result of an increase in extracellular adenosine in ischemic preconditioning.…”

Thoracic compartment syndrome after penetrating heart and lung injury

“…With a 16 Charrière urinary catheter up to 250 ml/minute can be administrated. The intravenous administration of adenosine (Adrekar ® : 0,15–0,30 mg/kg KG) leads, through to a short block of the AV (atrioventricular) node, to an asystole, which simplifies the treatment of heart injuries [ 19 ], [ 21 ].…”