Levosimendan treatment for severe myocardial contusion after blunt chest trauma: case report

Introduction: Cardiac contusion is usually caused by blunt chest trauma and therefore is frequently suspected in patients involved in car or motorcycle accidents. In patients with severe clinical manifestations, management with intubation, fluids, vasopressors, and inotropes is the treatment of choice. Levosimendan is a new inodilator agent that is reported to increase calcium sensitivity in myocardium. The purpose of this report is to describe a successful treatment with levosimendan in a case of myocardial contusion associated with cardiogenic shock. Case description: A 28-years-old woman victim of a motor vehicle accident, was admitted to the hospital with diagnosis of polytrauma. After she was submitted to surgical treatment fracture of tIbia and femur, she developed cardiac arrest twice with progressive hemodynamic deterioration with cardiogenic shock. She was managed with invasive monitoring, hemodynamic and ventilatory support. After twenty four hours, levosimendan infusion was initiated because there was not improvment with traditional inotropic drugs. Patient had amelioration in clinical status and was discharged from the intensive care unit. Conclusions: In literature there are data supporting levosimendan treatment of severe heart failure. Recent experimental small-scalle clinical studies and randomized clinical trials have led to a greater interest in the use of this drug, mainly in patient with impaired cardiac function with ischaemic heart disease and cardiogenic or septic shock. To date there was not report regarding the use of levosimendan in myocardial contusion.