A Case Report of Blunt Aortic Trauma in a Difficult Anatomic Location with Emergent Intraoperating Room Extracorporeal Membrane Oxygenation

IntroductIonAmong nonpenetrating traumatic injuries, blunt thoracic aortic injury (BTAI) is the second most common cause of mortality, second to intracranial hemorrhage. 1 Chest X-ray (CXR) can screen for widened mediastinum, which may be a sign of aortic rupture or mediastinal hematoma. 2Although routinely used in severe trauma, mediastinal abnormalities on CXR are not sensitive and cannot serve as the sole screening criteria for BTAI.The use of computed tomography (CT) should be considered depending on CXR findings and mechanisms of injury in order to accurately diagnose BTAI. 3 If the patient is not stable, then the timing of CT depends on how the patient responds to damage control management.Once the BTAI is diagnosed, the timing and optimal repair in young patients remain in question.This is especially related to the precise anatomical location of the injury, the extent of the injury, and concurrent injuries.Here, we share a multitrauma case involving emergent extracorporeal membrane oxygenation (ECMO) and proximal descending thoracic aortic injury in a young male. case descrIptIonA 20-year-old male was found at the scene after a high-velocity motorcycle accident.The victim had a decreased level of consciousness and was suffering from abdominal to chest pain.After scoop-and-run to our trauma center, the patient arrived at our trauma bay with no external signs of bleeding, a patent airway, tachypnea what abrasions and contusions to anterior chest/torso, cool and clammy with weak and rapid central pulses, abdominal and chest tenderness, 1,