title: Delayed visceral bleeding from liver injury after cardiopulmonary resuscitation.
abstract: 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.
authors.affiliation: Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Kouzu
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hase
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kokubu
authors.forename: Junichi
authors.initials: J
authors.lastname: Nishida
authors.forename: Mina
authors.initials: M
authors.lastname: Kawamukai
authors.forename: Yoko
authors.initials: Y
authors.lastname: Usami
authors.forename: Naoki
authors.initials: N
authors.lastname: Hirokawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Meguro
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Tsuchihashi
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Miura
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Asai
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimamoto
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D006493:Heparin