Intrahepatic and intracardiac gas on postmortem computed tomography in patients with nontraumatic cardiopulmonary arrest

Abstract

Objective:The goals of this retrospectively study were to examine the incidences of intrahepatic and intracardiac gas using postmortem computed tomography (PMCT) in patients with nontraumatic cardiopulmonary arrest treated by cardiopulmonary resuscitation with clinical factors, and to examine the cause of occurrence of intrahepatic and intracardiac gas by cardiopulmonary resuscitation. Design: The incidences of intrahepatic and intracardiac gas were investigated related to age, sex, place of intubation, duration of cardiopulmonary resuscitation, total dose of epinephrine, history of treatment with an automatic cardiopulmonary resuscitation device, number of catheters, drip infusion at a tube-indwelled site, return of spontaneous circulation, bystander CPR, infection, central venous catheterization, witness to cardiac arrest, gastric distension, and presence of the other gas (intrahepatic or intracardiac). Setting: Emergency department. Patients: The subjects were 286 patients aged ≥ 18 years old with nontraumatic cardiopulmonary arrest in whom cardiopulmonary resuscitation was performed, but death occurred. Interventions: PMCT was performed within one hour after death. Measurements and Main Results:The incidence of intrahepatic gas was 24.1% (69/286) and that of intracardiac gas was 31.1% (89/286). In univariate analysis, the presence of intrahepatic gas was significantly associated with the absence of a witness to cardiac arrest and the presence of gastric distension and intracardiac gas, and the presence of intracardiac gas was significantly associated with the absence of a witness to cardiac arrest and the presence of gastric distension and intrahepatic gas. In multivariate analysis, the presence of intrahepatic gas was significantly associated with the absence of a witness to cardiac arrest and the presence of gastric distension and intracardiac gas, and the presence of intracardiac gas was significantly associated with the presence of gastric distension and intrahepatic gas. Conclusions: Intrahepatic and intracardiac gas observed on PMCT in patients with nontraumatic cardiopulmonary arrest treated with cardiopulmonary resuscitation are related to each other, and gastric distention caused by cardiopulmonary resuscitation may have influenced the production of both gases. (JJAAM. 2012; 23: 757-67)