Massive Pulmonary Embolism With Liver Injury Associated With Chest Compressions During Cardiac Resuscitation

Yamasaki, Manabu; Misumi, Hiroyasu; Abe, Kohei; Kuwauchi, Shintaro; Ito, Joji; Kawazoe, Kohei

doi:10.1016/j.athoracsur.2013.09.044

Cited by 8 publications

(4 citation statements)

References 7 publications

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“…Although this postulation is appealing, there are not any studies supporting it, since it is relatively rare. However, there are few cases reporting liver injury following cardiac compressions in patients with PE [ 4 , 10 ]. PE compromises cardiac function, leading to parenchymal organ stasis.…”

Section: Discussionmentioning

confidence: 99%

Intra-Abdominal Hemorrhage following Cardiopulmonary Resuscitation: A Report of Two Cases

Koutserimpas

Ioannidis

Siaperas

et al. 2018

Case Reports in Emergency Medicine

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Cardiopulmonary resuscitation (CPR) represents an emergency procedure, consisting of chest compressions and artificial ventilation. Two rare cases of intra-abdominal bleeding following cardiac compressions are reported. The first case was a 29-year-old female with massive pulmonary embolism (PE). Following CPR due to cardiac arrest, she showed signs of intra-abdominal bleeding. A liver laceration was found and sutured. The patient passed away, due to massive PE. The second patient was a 62-year-old female, suffering from cardiac arrest due to drowning at sea. CPR was performed in situ. At presentation to the emergency department she showed signs of intra-abdominal bleeding. The origin of the hemorrhage was found to be vessels of the lesser curvature of the stomach, which were ligated. Regarding the first patient PE has already been described as a cause for liver lacerations in CPR due to stasis and liver enlargement. The second case is the first report of gastric vessel injury without gastric rupture/laceration and pneumoperitoneum. Complications of CPR should not represent a drawback to performing cardiac compressions. Parenchymatic injuries have been related to inappropriate technique of chest compressions during basic life support. Therefore, it is of utmost importance for the providers to refresh their knowledge of performing CPR.

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Section: Discussionmentioning

confidence: 99%

Intra-Abdominal Hemorrhage following Cardiopulmonary Resuscitation: A Report of Two Cases

Koutserimpas

Ioannidis

Siaperas

et al. 2018

Case Reports in Emergency Medicine

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“…caused by backward failure of the right heart have a higher risk for liver laceration during CPR but the connection is theoretically appealing. There are case-reports of liver injury after CPR due to PE [4]. Joseph et al described a liver bleed flowing prolonged resuscitation of a PE induced circulatory collapse [5].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary emboli cardiac arrest with CPR complication: Liver laceration and massive abdominal bleed, a case report

Lundqvist

Jakobsson

2017

International Journal of Surgery Case Reports

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HighlightsLarge pulmonary emboli may cause forward as well as backward cardiac failure.Large pulmonary emboli and subsequent backwards stasis may increase the risk for parenchymal organ swelling.CPR should be readily initiated in cause of cardiac arrest.External forces e.g. CPR may cause hepatic rupture and profound bleeding.Positioning of the manual as well as mechanical compression during CPR should be frequently be controlled.

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“…Liver injuries are infrequent complications of CPR, with a reported incidence of approximately 0.6 % [ 1 , 2 , 7 ]. A high degree of awareness is required to make an early diagnosis of life-threatening bleeding caused by a liver injury after initial successful CPR [ 2 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

Minimal invasive treatment of life-threatening bleeding caused by cardiopulmonary resuscitation-associated liver injury: a case report

et al. 2016

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BackgroundLife-threatening bleeding caused by liver injury due to chest compressions is a rare complication in otherwise successful cardiopulmonary resuscitation. Surgical intervention has been suggested to achieve bleeding control; however, reported mortality is high. In this report, we present a brief literature review and a case report in which use of a less invasive strategy was followed by an uneventful recovery.Case presentationA 37-year-old white woman was admitted after out-of-hospital cardiac arrest. Bystander cardiopulmonary resuscitation was immediately performed, followed by advanced cardiopulmonary resuscitation that included tracheal intubation, mechanical chest compressions, and external defibrillation with return of spontaneous circulation. Upon hospital admission, the patient’s blood pressure was 94/45 mmHg and her heart rate was 110 beats per minute. Her electrocardiogram showed no signs of ST-segment elevations or Q-wave development. Coronary angiography revealed a proximal thrombotic occlusion of the left anterior descending coronary artery. Successful recanalization, after thrombus aspiration and balloon dilation followed by stent implant, was verified with normalized anterograde flow. Immediately after the patient’s arrival in the intensive cardiac care unit, a drop in her blood pressure to 60/30 mmHg and a hemoglobin concentration of 4.5 g/dl were noticed. Transfusion was started, and bedside abdominal ultrasound examination revealed free intraperitoneal fluid. Computed tomography of the abdomen revealed liver injury with active extravasation from the cranial surface of the right lobe and a massive hemoperitoneum. The patient was coagulopathic and acidotic with a body temperature of 33.5 °C. A minimally invasive treatment strategy, including angiography and selective trans-catheter arterial embolization, were performed in combination with percutaneous evacuation of 4.5 L of intraperitoneal blood. After completion of these procedures, the patient was hemodynamically stable. She was weaned off mechanical ventilation 2 days later and made an uneventful recovery. She was discharged to a local hospital on day 13 without neurological disability.ConclusionsAlthough rare, bleeding caused by liver injury due to chest compressions can be life-threatening after successful cardiopulmonary resuscitation. Reported mortality is high after surgical intervention, and patients may benefit from less invasive treatment strategies such as those presented in this case report.

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Massive Pulmonary Embolism With Liver Injury Associated With Chest Compressions During Cardiac Resuscitation

Cited by 8 publications

References 7 publications

Intra-Abdominal Hemorrhage following Cardiopulmonary Resuscitation: A Report of Two Cases

Intra-Abdominal Hemorrhage following Cardiopulmonary Resuscitation: A Report of Two Cases

Pulmonary emboli cardiac arrest with CPR complication: Liver laceration and massive abdominal bleed, a case report

Minimal invasive treatment of life-threatening bleeding caused by cardiopulmonary resuscitation-associated liver injury: a case report

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