title: Cardiopulmonary resuscitation-associated major liver injury.
abstract: OBJECTIVE
  To evaluate the frequency, presentation, treatment and outcome of cardiopulmonary resuscitation-associated major liver injury in patients after non-traumatic in- or out-of-hospital cardiac arrest.
  
  
  METHODS
  Retrospective analysis of a cardiac arrest registry in a tertiary care hospital emergency department. We reviewed patients charts, laboratory data, diagnostic imaging studies and autoptic findings.
  
  
  RESULTS
  Within 14.5 years, major liver injury (rupture/laceration, haemorrhage/haematoma) was found in 15 of 2558 cardiac arrest victims (0.6%). Eleven were male (73%), median age was 58 (IQR 53-67). In seven, resuscitation was started out-of-hospital. In 9 of the 15 patients, liver injury was correctly diagnosed intra vitam. In 5, haematocrit level was low on admission, in 8 haematocrit dropped significantly during observation; haemostasis was compromised in 13 patients, 4 of them receiving thrombolytic therapy. Bedside abdominal sonography showed free intra-peritoneal fluid in 8 of 9 cases examined. In 11 patients, we found liver rupture/laceration, in 4 liver haemorrhage/haematoma. The site of injury was the left liver lobe in 11, six underwent emergent surgery. Two of 15 patients survived to 6 months in good neurological condition, 1 after emergency surgery. No patient died from bleeding due to liver injury.
  
  
  CONCLUSIONS
  Our single centre observation confirms that resuscitation-associated major liver injury is infrequent and shows that most patients had compromised haemostasis. Low or dropping haematocrit should trigger suspicion. Bedside sonography reveals intra-peritoneal fluid or liver injury. A conservative therapeutic approach or emergency surgery may be warranted. Major liver injury alone scarcely appears to influence overall outcome.
authors.affiliation: Department of Emergency Medicine, General Hospital of Vienna, Medical University of Vienna, Austria.
authors.forename: Giora
authors.initials: G
authors.lastname: Meron
authors.forename: Istepan
authors.initials: I
authors.lastname: Kurkciyan
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.forename: Martin
authors.initials: M
authors.lastname: Susani
authors.forename: Hans
authors.initials: H
authors.lastname: Domanovits
authors.forename: Karin
authors.initials: K
authors.lastname: Tobler
authors.forename: Arthur
authors.initials: A
authors.lastname: Bohdjalian
authors.forename: Anton N
authors.initials: AN
authors.lastname: Laggner
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000706:statistics & numerical data*; D003288:Contusions; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D022125:Lacerations; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012421:Rupture; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy