Successful surgical repair of blunt traumatic cardiac rupture with V-A ECMO initiated during open cardiac massage: a case report.

Blunt traumatic cardiac rupture is a rare and frequently fatal injury. The role of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) during active surgical resuscitation remains uncertain. A 55-year-old man was transported to our hybrid emergency room in profound shock after a motorcycle collision. Focused Assessment with Sonography for Trauma demonstrated pericardial effusion with cardiac tamponade. Emergency resuscitative thoracotomy and pericardiotomy revealed a right ventricular rupture. Despite manual compression of the rupture site and open cardiac massage, the patient developed cardiac arrest. V-A ECMO was initiated during the ongoing open cardiac massage 12 min after cardiac arrest. After restoration of systemic circulation, an approximately 2-cm right ventricular rupture was primarily repaired. Cardiac function promptly recovered, permitting successful weaning from V-A ECMO immediately after repair. Subsequent imaging revealed a blunt thoracic aortic injury, an unstable pelvic fracture, and thoracic spine fractures, that were treated with staged definitive interventions. The patient was discharged 6 months after the injury and resumed an independent life without significant neurological or functional disabilities. This case suggests that V-A ECMO initiated during open cardiac massage may provide temporary circulatory support and serve as a bridge to definitive repair in selected patients with blunt traumatic cardiac rupture and refractory circulatory collapse. Successful implementation requires immediate surgical hemorrhage control, rapid ECMO deployment, and a coordinated multidisciplinary trauma system.