Diaphragmatic rupture and massive pneumoperitoneum after cardiopulmonary resuscitation

Abstract

Introduction: Although cardiopulmonary resuscitation is an emergency life-saving procedure, the intervention itself can cause major and often fatal injuries, with diaphragmatic rupture being very rare. This report describes a patient who experienced bilateral pneumothoraces, left diaphragmatic rupture, and pneumoperitoneum after extended cardiopulmonary resuscitation. Case presentation: A 90-year-old woman experienced a cardiac arrest. Spontaneous circulation was restored after 49 min of cardiopulmonary resuscitation performed by a bystander, emergency medical service providers, and emergency department staff. Imaging showed bilateral pneumothoraces, left diaphragmatic rupture, and massive pneumoperitoneum. The patient’s guardian refused to permit surgery for the diaphragmatic rupture, and the patient died despite chest and abdominal decompression and post-cardiac arrest care. Discussion and conclusion: Procedures to restore spontaneous circulation in patients experiencing cardiac arrest may result in fatal cardiopulmonary resuscitation–related injuries. Clinicians providing post-cardiac arrest care should plan management for these iatrogenic injuries.

Isolated injury of the caudate lobe of the liver due to cardiopulmonary resuscitation

“…Splenic injuries, though rarer, have also been reported in association with CPR, though typically in combination with incorrect hand placement during chest compressions [21]. Diaphragmatic injury is less common in relation to CPR; though it has been identified in several case reports [22][23][24].…”

Injuries after cardiopulmonary resuscitation in the pre-hospital and hospital care in two regions of the Czech Republic: retrospective observational cohort study

“…Fatal injuries caused by the resuscitation (CPR) related to chest compressions (CC) are less Page 3/10 common but very serious. These injuries most often include heart injuries (cardiac tamponade, rupture of the right ventricle), lacerations of the lungs, injuries of the intra-abdominal organs (laceration of the liver lobe, injury to the pancreas, ruptures of the diaphragm) [2,[5][6][7][8].…”

“…Fatal injuries caused by the resuscitation (CPR) related to chest compressions (CC) are less Page 3/10 common but very serious. These injuries most often include heart injuries (cardiac tamponade, rupture of the right ventricle), lacerations of the lungs, injuries of the intra-abdominal organs (laceration of the liver lobe, injury to the pancreas, ruptures of the diaphragm) [2,[5][6][7][8].Lower frequency of research dealing with intrathoracic injuries and drawing attention to the occurrence of heart lesions, which are a signi cant complication related to chest compressions was reported by previous research [2].Limited data was reported about the different ways of performed CC compared to the autopsy ndings, especially when cardio pump is used. The aim of this study is to analyse the corelation between the way the chest compressions were applied and the types of injury in deceased patients who underwent CPR for sudden cardiac arrest of non-traumatic aetiology.…”