Maxwell Christopher William, Carson Joshua, Kaufmann Michael R, Fahy Brenda G
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.
Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA.
Rom J Anaesth Intensive Care. 2019 Apr;26(1):79-82. doi: 10.2478/rjaic-2019-0012.
Annual implants of cardiovascular implantable devices (CIEDs) are increasing, thus increasing the risk of device exposure. This case presents CIED management issues following traumatic thermal injury. A 59-year-old female presented to intensive care with 42% total body surface area burn involving tissue over her pacemaker generator. Electrophysiologists interrogated and reprogrammed the pacer and observed the patient over 72 hours without pacing. Serratia bacteremia developed and cardiology recommended device removal. The pacemaker generator and leads were removed by cardiothoracic and burn surgery. Postoperatively, asystole required emergency transvenous pacing wire placement. During bacteremia treatment, cardiology planned to pace with an active-fixation screw-in lead with long-term plans to place a single right ventricular chamber leadless pacemaker because of the extensive burns. The patient developed fungemia and the family opted for comfort care. This case report discusses the management of a CIED exposed after a traumatic thermal burn, including device extraction.
心血管植入式电子设备（CIED）的年度植入量不断增加，从而增加了设备外露的风险。本病例介绍了创伤性热损伤后CIED的管理问题。一名59岁女性因起搏器发生器上方42%的体表面积烧伤入住重症监护病房。电生理学家对起搏器进行了问询和重新编程，并在72小时内观察患者未进行起搏。患者出现了沙雷氏菌血症，心脏病专家建议移除设备。起搏器发生器和导线由心胸外科和烧伤外科医生取出。术后，心脏停搏需要紧急放置经静脉起搏导线。在菌血症治疗期间，心脏病专家计划使用主动固定螺旋电极进行起搏，并长期计划植入单腔右心室无导线起搏器，因为烧伤范围广泛。患者出现真菌血症，家属选择了舒适护理。本病例报告讨论了创伤性热烧伤后外露的CIED的管理，包括设备取出。
