# Chest Wound Gunshot Management Aided by Cardiopulmonary Bypass: Interdisciplinary Teamwork or “Serendipity”?

## TL;DR

A patient with a severe chest gunshot wound was successfully treated using cardiopulmonary bypass and lung repair, highlighting the importance of interdisciplinary teamwork.

## Contribution

This case demonstrates the successful use of emergency cardiopulmonary bypass in managing a complex chest wound.

## Key findings

- Emergency cardiopulmonary bypass enabled successful lung repair in a patient with a life-threatening chest wound.
- Interdisciplinary teamwork and advanced equipment were critical to the patient's survival.
- The patient was discharged 20 days after the procedure, indicating a positive clinical outcome.

## Abstract

Background and clinical significance. Penetrating cardiothoracic wounds require prompt treatment in order to decrease mortality and morbidity. Surgical therapy, aimed at bleeding control and removal of damaged tissue, varies widely from the direct suture of parenchymal lacerations to pneumonectomy, which is characterized by high mortality rates. We report our experience with a patient in hemorrhagic shock due to a gunshot wound to the chest, successfully treated by pneumorrhaphy under cardiopulmonary bypass (CPB). Case presentation. A 53-year-old man with a gunshot wound to the chest was admitted to our Emergency Department. A bedside ultrasonography revealed left pleural and pericardial effusion. He was hemodynamically instable, so he was immediately transferred to the operating room by the cardiac and Thoracic Surgery teams. Through a median sternotomy approximately 2 L of blood were evacuated and a deep laceration of the left upper lobe was discovered. The massive bleeding could not be controlled, leading to pleural cavity flooding. The surgical team decided to institute emergency CPB and perform lung repair by pneumorrhaphy, under circulatory support. The patient survived and was discharged on p.o. day 20. Conclusions. Clinical expertise, adequate instrumental equipment and a high level of interdisciplinary team-work favorably affected the patient’s outcome.