Delayed visceral bleeding from liver injury after cardiopulmonary resuscitation.
BACKGROUND
Visceral injury is a life-threatening complication of cardiopulmonary resuscitation (CPR); however, the clinical significance has been masked by the lethal outcome of out-of-hospital cardiac arrest (OHCA).


OBJECTIVE
The objective is to share our experience of successful treatment of OHCA patients with serious, CPR-related visceral complications.


METHODS
We report two cases of cardiac-origin OHCA with liver injury exacerbated by heparinization during mechanical circulatory support. Although both patients presented with delayed massive liver bleeding (intrahepatic or peritoneal) that compromised hemodynamic status, one patient was successfully treated by selective transcatheter arterial embolization and the other by a surgical procedure.


CONCLUSIONS
Preventive measures such as careful CPR, as well as interventional or surgical repair after the early diagnosis of visceral injury, are required to improve the outcome in some cases of OHCA.
Kouzu
Hidemichi
H
Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Hase
Mamoru
M
Kokubu
Nobuaki
N
Nishida
Junichi
J
Kawamukai
Mina
M
Usami
Yoko
Y
Hirokawa
Naoki
N
Meguro
Makoto
M
Tsuchihashi
Kazufumi
K
Miura
Tetsuji
T
Asai
Yasufumi
Y
Shimamoto
Kazuaki
K
D000925:Anticoagulants / Q000009:adverse effects*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy
D000925:Anticoagulants; D006493:Heparin