Cardiogenic refractory hypoxaemia secondary to blunt chest trauma: diagnosis by transoesophageal echocardiography

A 53 year old man suffered severe head and blunt chest trauma as a result of a fall (from four metres high). On arrival at the emergency room he was unconscious with hypovolaemic circulatory shock. Following orotracheal intubation and resuscitation with blood, inotropic agents, and crystalloid, he was transferred to the neurosurgical intensive care unit. Analysis of arterial blood gases revealed a Pao2 of 50 mm Hg, Paco 2 35 mm Hg, and pHa 7.47. Increase in FIo2 up to 1.0 did not result in any increase in Pao2. Ventilation with positive end expiratory pressure made the hypoxaemia more severe. Pulmonary embolism was excluded by lung scintigraphy, mild right pulmonary contusion was evident on computed tomography; pneumothorax was not evident using …