CASE REPORT article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1650387
This article is part of the Research TopicState of the Art in Acute Care Surgery: Application, Innovation, and Future PerspectivesView all 9 articles
Successful treatment of recurrent traumatic cardiac arrest due to splenic rupture in trauma resuscitation unit: a case report
Provisionally accepted
- 1The People's Hospital of Haiyan, Jiaxing, China
- 2Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Recurrent traumatic cardiac arrest (rTCA) represents a critical emergency with mortality rates exceeding 96% and limited neurological recovery among survivors. High-quality evidence to guide standardized management remains scarce. We report the case of a 67-year-old male presenting with rTCA secondary to Grade IV splenic rupture following a high-impact traffic collision. Upon emergency department arrival, the patient experienced cardiac arrest, achieving temporary return of spontaneous circulation before a second arrest 8 minutes later due to massive intra-abdominal hemorrhage. Focused assessment with sonography for trauma (FAST) and diagnostic paracentesis confirmed splenic rupture as the primary cause. Due to persistent hemodynamic instability precluding transfer, emergency laparotomy was determined 10 minutes post-arrival and performed in the trauma resuscitation unit (TRU) 25 minutes latter. Intraoperatively, 2500 mL of blood and 300 g of clots were evacuated, followed by splenectomy for definitive hemostasis. Aggressive resuscitation, including tranexamic acid, prothrombin complex concentrate, and packed red blood cell transfusion within 23 minutes, alongside multidisciplinary intensive care, facilitated hemodynamic stabilization within 48 hours. Full neurological recovery was evident by day 5, with successful extubation on day 7 and discharge on day 25 with restored functional independence. This case highlights three key principles for rTCA management: (1) surgical strategy (laparotomy versus thoracotomy) and venue (TRU versus operating room) must be informed by integrated injury assessment and hemodynamic status; (2) early hemostatic control is critical to interrupting recurrent arrests; and (3) multimodal, goal-directed resuscitation and interdisciplinary collaboration are essential for optimizing survival and neurological outcomes. These insights offer a robust framework for trauma teams managing complex rTCA cases.
Keywords: traumatic cardiac arrest, Splenic Rupture, Resuscitation, Emergency laparotomy, hemorrhagic shock
Received: 19 Jun 2025; Accepted: 21 Aug 2025.
Copyright: © 2025 Gu, Hu, Zhao, Shen, Gu, Han, Jiang and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Shou-Yin Jiang, Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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