Ruptured subcapsular liver haematoma following mechanically-assisted cardiopulmonary resuscitation

Abstract

SUMMARYA 64-year-old man with a history of ascending aortic surgery and pulmonary embolus presented with shortness of breath. He rapidly decompensated, prompting intubation, after which he lost pulses. Manual resuscitation was initiated immediately, with subsequent use of a LUCAS-2 mechanical compression device. The patient was given bolus thrombolytic therapy and regained pulses after 7 min of CPR. Compressions were reinitiated with the LUCAS-2 twice more during resuscitation over the subsequent hour for brief episodes of PEA. After confirmation of massive pulmonary embolism on CT, the patient underwent interventional radiology-guided ultrasonic catheter placement with local thrombolytic therapy and experienced immediate improvement in oxygenation. He later developed abdominal compartment syndrome, despite cessation of thrombolytic and anticoagulation therapy. Bedside exploratory abdominal laparotomy revealed a ruptured subcapsular haematoma of the liver. The patient's haemodynamics improved following surgery and he was extubated 11 days postarrest with intact neurological function. BACKGROUND

Thinking Outside the "Box": Severe Intra-Abdominal Bleeding Due to Liver Injury Post CPR

“…Liver injuries are the most common [5] intra-abdominal complications following CPR, with an approxi-…”

“…The left liver lobe is mainly affected due to its proximity the sternum [2]. Antiplatelet, antithrombotic and thrombolytic treatments especially in patients with suspected myocardial infarction or pulmonary embolism have been cited as contributing factors for intra-abdominal hemorrhage [5][6][7]. Liver injury and intra-abdominal bleeding can either be missed or diagnosed late (hospital day 2 or later) [3,5].…”

“…Antiplatelet, antithrombotic and thrombolytic treatments especially in patients with suspected myocardial infarction or pulmonary embolism have been cited as contributing factors for intra-abdominal hemorrhage [5][6][7]. Liver injury and intra-abdominal bleeding can either be missed or diagnosed late (hospital day 2 or later) [3,5]. Therefore the true incidence may be underreported, particularly in unconscious patients or patients were support is felt to be futile and full evaluations are felt to be irrelevant.…”

“…Fractured ribs and sternums, aspiration pneumonia, and mediastinal hemorrhage have been well documented [2][3][4]. Less well-described are intra-abdominal complications, including stomach, spleen and liver injuries [5]. Significant liver injuries, though rare, when misdiagnosed or addressed late in the patient's hospital course, may lead to poor outcomes [3,4,6].…”

Pulmonary emboli cardiac arrest with CPR complication: Liver laceration and massive abdominal bleed, a case report

“…There are case-reports of liver injury after CPR due to PE [4]. Joseph et al described a liver bleed flowing prolonged resuscitation of a PE induced circulatory collapse [5]. CPR per see may in a low incidence cause abdominal bleed caused by laceration injury to the liver [6].…”