Acute Cardiac Tamponade; a Case of Life-threatening COVID-19 Complication during Aeromedical Transportation

Darvishi, Mohammad; Shahali, Hamze

A 42-year-old man with COVID-19 pneumonia was admitted to a small town hospital that did not have Intensive Care(ICU) level of resources available.Twelve hours later, the patient suddenly became agitated, and an extensive anterolateral ST-elevation myocardial infarction was detected by 12-lead EKG and supported by a rise in serum cardiac enzymes.Low blood oxygen saturation(59%) and cardiac ejection fraction(EF=20%) reflected criticality that could potentially require cath lab, CABG surgery, and ICU level of resources.Following coordination of physicians with the nearest equipped hospital and aeromedical crew(AMC), a Mil Mi-17 medical helicopter unit was dispatched.About 20 minutes before reaching the destination hospital, his clinical condition declined, as HR=50beats/min, BP=75/40mmHg and jugular veins distention.Muffled heart sounds, decreased voltage in EKG and accumulation of pericardial effusion via bedside Ultrasound indicated cardiac tamponade.AMC resuscitated the patient through the interventions of intubation, mechanical ventilation, administration of intravenous fluids, and initiation of an Epinephrine infusion.Ultrasound-guided pericardiocentesis was performed in the helicopter which kept him alive until pericardotomy could be performed at the destination hospital.Unfortunately, after pericardiotomy and CABG surgery, the patient died 7 days later in the ICU due to severe cardiopulmonary failure.