Frequent and rare complications of resuscitation attempts

Buschmann, C.; Tsokos, Michael

doi:10.1007/s00134-008-1255-9

Cited by 186 publications

(145 citation statements)

References 35 publications

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“…Estimates of the incidence of some type of resuscitation injury ranges from 21%-65%, 1 and up to 97.4%. 2 Although these injuries infrequently have a significant effect on the patient's outcome, 3 clinicians should be mindful that anterior-posterior chest radiographs underestimate true fracture frequency. 2 Hashimoto et al 1 reported that CPR results in an average of 7.1 broken ribs, with ribs 3-5 being the most frequently involved.…”

Section: Discussionmentioning

confidence: 99%

“…Rib injuries occur with greater frequency in women and with increased age. 3 Other CPR-associated injuries that occur with notable frequency (>20% of autopsy cases) include chest abrasion/contusion, defibrillator burns, sternal fractures, upper airway injuries, and pulmonary edema. …”

Section: Discussionmentioning

confidence: 99%

“…3 A rare complication of CPR is trauma to the heart and associated structures (e.g., great vessels and pericardium). Krischer et al 4 reviewed 700 autopsy cases involving CPR and found vena cava trauma in 0.9% of cases and myocardial contusion in 1.3% of cases.…”

Section: Cjem Jcmumentioning

confidence: 99%

“…Rib fractures are the most common injury, and women of increased age, especially with osteopenia/osteoporosis, are in the highest risk demographic. 3 Although uncommon, injuries to the respiratory tract, gastroesophageal tract, upper abdominal organs, and cardiovascular system can all result from CPR and may present life-threatening injury in the post-resuscitation period. An assessment for iatrogenic myocardial injury in patients receiving CPR for diffuse pulmonary emboli should be considered.…”

Section: Cjem Jcmumentioning

confidence: 99%

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CPR-associated right ventricular rupture in the setting of pulmonary embolism

Hickey

Gill

Seidman

et al. 2016

CJEM

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Cardiopulmonary resuscitation (CPR) is an inherently traumatic procedure. Successful resuscitations are often complicated by iatrogenic injuries to structures of the neck, thorax, or abdomen. Rib and sternal fractures are the most frequently induced injuries. However, rare and life-threatening trauma to vital organs such as the heart may also occur during CPR. We describe a novel case of CPR-associated right ventricular rupture in a woman with acute-on-chronic pulmonary embolism and no known pre-existing cardiac disease. We propose that chest compressions in the setting of elevated right ventricular pressure resulted in cardiac rupture, in this case. RÉSUMÉLa réanimation cardiorespiratoire (RCR) est en ellemême une manoeuvre traumatique. Les réanimations couronnées de succès se compliquent souvent de lésions iatrogènes aux structures du cou, du thorax ou de l'abdomen. Les fractures de côtes ou du sternum sont les lésions les plus fréquentes attribuables à la RCR. Toutefois, il peut arriver que des traumas extrêmement graves soient causés à des organes vitaux comme le coeur, mais le phénomène est rare. Sera exposé ici un nouveau cas de rupture du ventricule droit, associée à la RCR chez une femme ayant subi une embolie pulmonaire aiguë accompagnée de signes chroniques, mais ne souffrant pas d'une maladie cardiaque préexistante connue. Aussi sommes-nous d'avis que les compressions thoraciques effectuées dans le contexte d'une pression ventriculaire droite élevée se sont soldées par la rupture de la structure cardiaque.Keywords: autopsy, resuscitation, cardiac injury, iatrogenic, pulmonary embolism CASE REPORTA 79-year-old woman with osteoporosis, dyslipidemia, and 1 year of unexplained weight loss (less than 30 lb) was on her way to see her family physician. She had booked the appointment because she had been feeling generally unwell and fatigued for several weeks-her condition worsening in recent days. She collapsed in her residential driveway, and paramedics attended to her within 10 minutes. At the scene, she was pulseless with agonaltype respirations, and the paramedics initiated CPR. On arrival at the local emergency department, the patient had a Glasgow Coma Scale of 3 and vital signs were absent. In the hospital, the patient received continued standard resuscitative efforts, including chest compressions, four external cardiac defibrillation attempts, oxygen delivery via bag-valve-mask and boluses of epinephrine, calcium, and bicarbonate. Chest compressions resulted in rib fractures and an unusual swelling of the right neck. The patient never achieved return of spontaneous circulation, and the health care providers ceased resuscitation efforts after 25 minutes of standard total CPR protocol.A postmortem examination was requested to determine the cause of death. On opening the thorax, extensive blood was present throughout the soft tissues

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Cjem Jcmumentioning

confidence: 99%

Section: Cjem Jcmumentioning

confidence: 99%

See 2 more Smart Citations

CPR-associated right ventricular rupture in the setting of pulmonary embolism

Hickey

Gill

Seidman

et al. 2016

CJEM

View full text Add to dashboard Cite

show abstract

“…Myocardial ischemia caused by acute coronary occlusion can lead to the development of ventricular fibrillation. PCI was thought to be useful in patients with acute ST elevation myocardial infarction (STEMI), [20,21] and it was also beneficial to patients after recovery of spontaneous circulation. [22] Sunde et al [23,24] found that the mortality of patients treated with PCI (n=12) was signifi cantly lower than that of patients treated conservatively (n=20) (17% vs. 70%).…”

Section: Percutaneous Coronary Intervention (Pci)mentioning

confidence: 99%