A possible underlying mechanism of gastric mucosal ruptures due to resuscitation efforts

Abstract

introduction The occurrence of gastric mucosal ruptures during cardiopulmonary resuscitation (CPR) is contributed to extensive gastric distention, either due to mouth-to-mouth resuscitation or the use of a bag and mask, or inappropriate intubation that may lead to gastric hyperinflation, which then creates gastric distension and further promotes gastric rupture. The presented case suggests that there might be another mechanism -chest compressions during CPR. Case outline We present a case of an 84-year-old woman who died due to severe chronic ischemic heart disease after unsuccessful resuscitation. The autopsy revealed a presence of several shallow ruptures of gastric mucosa on the lesser curvature, 1-3 cm in length, with surrounding mucosal hemorrhage, and without bleeding in the gastric cavity. Conclusion Gastric mucosal ruptures could occur due to a combination of two mechanisms: pressure propagation due to chest compression and gastric hyperinflation.