[Acute heart insufficiency of primarily non-cardiac origin after polytrauma]

The following approach is proposed for treatment of the hemodynamics resulting from severe trauma. Blood pressure and pulse frequency are measured whilst volume is added until peripheral circulation returns to normal or until CVP attains 13 mm Hg (under CPPV, PEEP 10 cm H2O). When CVP attains 13 mm Hg a pulmonary-arterial thermodilution catheter is introduced and transfusion continued, possibly up to a PCWP of 17 mm Hg. At this stage, 4 different haemodynamic groups may be distinguished and are described on the basis of the mean values recorded for 3 patients in each group: 1. SVRI increased, LVSWI and PVRI normal.

continued slow addition of volume. 2. SVRI and PVRI slightly elevated. LVSWI diminished. CI and VO2 adequate.

phentolamine. 3. PVRI slightly elevated, CI and VO2 too low, i.e. left cardiac insufficiency.

isuprel. 4. PVRI markedly elevated, CI and VO2 clearly diminished, i.e. biventricular cardiac insufficiency with pulmonary-vascular hypertension.

isuprel and phentolamine. Pharmacological therapy can be discontinued after a few days and hemodynamics remain normal. These observations show that "acute cardiac failure in fundamentally normal hearts" can occur after severe trauma and that treatment is possible.