Damage control surgery in a patient with cardiac arrest from necrotizing soft tissue infection

• Published in: Trauma surgery & acute care open Vol. 9; no. 1; p. e001428
• Main Authors: Shi, Jianshe, Zheng, Jialong, Zhang, Yong, Chen, Yijie, Zhang, Chenghua
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.10.2024; BMJ Publishing Group
• Subjects: Abdomen; Abscesses; Blood platelets; Cardiac arrest; Consent; Creatinine; Debridement; Diabetes; Drug resistance; Ethics; Failure; Gangrene; Infections; Inflammation; Intensive care; Laparotomy; Medical imaging; Mortality; Multiple organ dysfunction syndrome; Necrotizing fasciitis; Patients; Physiology; Sepsis; Surgery; Trauma
• ISSN: 2397-5776; 2397-5776
• DOI: 10.1136/tsaco-2024-001428

Continue extensive and thorough debridement despite septic shock, multiple organ failure, and post-cardiopulmonary resuscitation Recommend end-of-life care to the patient’s family based on the poor prognosis. What we did and why To control sepsis, all infected necrotic tissue must be removed.1 However, considering the patient’s condition, additional surgical trauma and anesthesia could precipitate another cardiac arrest.2 Therefore, we performed damage control surgery, suspending the debridement and inserting multiple dual-lumen tube suction and sump drains. [...]the damage control surgery (DCS) strategy was implemented, which involves a staged approach to surgery with initial focus on immediate life-threatening conditions. [...]incomplete debridement during the initial procedure necessitates delayed thorough debridement and an extended antibiotic regimen, likely facilitating the development of drug-resistant bacterial strains. [...]persistent and ongoing systemic inflammation due to residual infection can lead to a protracted state of persistent inflammation, immunosuppression, and catabolic syndrome, considerably lengthening ICU and hospitalization stays.8 Hence, this clinical decision needs careful consideration and thorough debridement must be completed without delay once appropriate physiological conditions are achieved.