Tension pneumothorax secondary to automatic mechanical compression decompression device

Abstract

The details are presented of the first published case of a tension pneumothorax induced by an automatic compression-decompression (ACD) device during cardiac arrest. An elderly patient collapsed with back pain and, on arrival of the crew, was in pulseless electrical activity (PEA) arrest. He was promptly intubated and correct placement of the endotracheal tube was confirmed by noting equal air entry bilaterally and the ACD device applied. On the way to the hospital he was noted to have absent breath sounds on the left without any change in the position of the endotracheal tube. Needle decompression of the left chest caused a hiss of air but the patient remained in PEA. Intercostal drain insertion in the emergency department released a large quantity of air from his left chest but without any change in his condition. Post-mortem examination revealed a ruptured abdominal aortic aneurysm as the cause of death. Multiple left rib fractures and a left lung laceration secondary to the use of the ACD device were also noted, although the pathologist felt that the tension pneumothorax had not contributed to the patient's death. It is recommended that a simple or tension pneumothorax should be considered when there is unilateral absence of breath sounds in addition to endobronchial intubation if an ACD device is being used.

Computed tomography findings of complications resulting from cardiopulmonary resuscitation

“…We presume that these pneumothoraces were caused by injury of the pleura secondary to rib or sternal fractures. In some cases, tension pneumothorax may occur 9,22 . With regard to haemopericardium, there were 14 cases (6.3%) in the present study.…”

Chest Compression Injuries Detected via Routine Post-arrest Care in Patients Who Survive to Admission after Out-of-hospital Cardiac Arrest

“…12 Second, there is an emerging need for a systematic study of injuries associated with the novel mechanical compression devices that are becoming increasingly popular. 12 Case reports illustrating catastrophic injuries associated with their use have appeared in recent years, [13][14][15][16] but similar injuries have also been described in the context of manual compression 1,[17][18][19][20] and systematic studies are needed.…”

New Developments in Cardiac Arrest Management

“…For an overview of more mechanical devices from different manufacturers, please refer to recent review articles in this area [33,36]. Earlier studies have reported a higher incidence of rib and sternal fractures after manual ACD versus conventional manual CPR [37]; other case reports have described rare complications, such as tension pneumothorax [38] and liver [39] or splenic lacerations [40]. Nevertheless, neither of these are thought unique to automated versus conventional manual chest compressions [41].…”