Liver injury diagnosed on computed tomography after use of an automated cardiopulmonary resuscitation device

Abstract

We report a case of an 89-year-old female with active extravasation and hemoperitoneum from a liver laceration demonstrated on multidetector computed tomography (CT), attributed to the use of an automated mechanical cardiopulmonary resuscitation (CPR) device. Although iatrogenic internal injuries related to manual CPR and CPR devices have previously been reported [1, 2], there has been no reported CT evidence of liver injury related to automated CPR devices to the authors' knowledge. Imaging findings of complications related to the use of automated CPR devices are important to recognize and also help explain the possible mechanisms of injury. Liver injuries with active bleeding following CPR may have devastating consequences related to hemodynamic instability and may have an increased incidence when CPR is performed using an automated chest compression device.

Cardiopulmonary Resuscitation Complicated by Traumatic Hepatic Laceration: A Case Report and Review of Literature

“…Hepatic injury is the commonest of the CPR-related intra-abdominal complication with an approximate incidence of 0.6% [5,6,10,[13][14][15][16]. Splenic rupture ranks second [6].…”

“…It may well be that direct pressure to the xiphoid process during compressions is frequently responsible for these injuries [6], especially considering that several of the reported injuries have involved the anterior left hepatic lobe [5], but this has not been conclusively proven.…”

“…Included among these are cases of liver injury attributable to CPR-induced trauma. Interestingly, many of these reported cases cite that CPR was performed by the general bystander outside of a healthcare facility [2], although, notably, injuries have also been reported within healthcare facilities when performed by healthcare professionals [3,4], and even with the use of an automated CPR device [5,6].…”

Resuscitation complications encountered in forensic autopsy cases performed in XXX province.

“…Two other important factors that can increase the risk of liver laceration are hepatic ischaemia and liver distension due to venous obstruction. [10,[19][20][21][22][23][24][25][26] The reason for liver laceration in our case was thought to be similar. Moreover, treatments with antiplatelet, antithrombotic, and thrombolytic agents in patients with myocardial infarction may cause such lacerations.…”

“…In the literature, liver damage is seen at an incidence of ~0.6 3% and is the most frequent intra-abdominal complication related to CPR. [10,[19][20][21][22][23][24][25][26] Liver laceration was recorded in two of our cases and is observed more often on the left lobe. The most important factor in this is the close anatomical relationship between the left lobe of the liver and the sword-shaped lower end of the sternum.…”