Concealed resuscitation-related injuries as reversible cause of recurrent arrest following extracorporeal cardiopulmonary resuscitation.
A life-threatening cardiopulmonary resuscitation (CPR)-related injury can cause recurrent arrest after return of circulation. Such injuries are difficult to identify during resuscitation, and their contribution to failed resuscitation can be missed given the limitations of conventional CPR. Extracorporeal cardiopulmonary resuscitation (ECPR), increasingly being considered for selected patients with potentially reversible etiology of arrest, may identify previously occult CPR-related injuries by restoring arterial pressure and flow. Herein, we describe two cases of severe CPR-related injuries contributing to recurrent arrest. Each case had ECPR implemented within 60 minutes of the start of CPR. After the presumed cardiac etiology had been addressed with percutaneous coronary intervention, life-threatening cardiovascular injuries with recurrent arrest were noted, and resuscitative thoracotomy was performed under ECPR. One patient survived to hospital discharge. ECPR may provide an opportunity to identify and correct severe resuscitation-related injuries causing recurrent arrest. Chest compression depth >6 cm, especially in older women, may contribute to these injuries.
*Emergency Medicine,Subdivision of Cardiovascular Medicine,College of Medicine,Korea University,Seoul,South Korea.
Kap Su
KS
Han
*Emergency Medicine,Subdivision of Cardiovascular Medicine,College of Medicine,Korea University,Seoul,South Korea.
Sung Woo
SW
Lee
*Emergency Medicine,Subdivision of Cardiovascular Medicine,College of Medicine,Korea University,Seoul,South Korea.
Kwang Hoon
KH
Park
*Emergency Medicine,Subdivision of Cardiovascular Medicine,College of Medicine,Korea University,Seoul,South Korea.
Jong Su
JS
Park
†Thoracic and Cardiovascular Surgery,Subdivision of Cardiovascular Medicine,College of Medicine,Korea University,Seoul,South Korea.
Jae Seung
JS
Jung
‡Internal Medicine,Subdivision of Cardiovascular Medicine,College of Medicine,Korea University,Seoul,South Korea.
Cheol Woong
CW
Yu
*Emergency Medicine,Subdivision of Cardiovascular Medicine,College of Medicine,Korea University,Seoul,South Korea.
Su Jin
SJ
Kim
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006341:Heart Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D013902:Radiography, Thoracic / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome
cardiac injury; cardiopulmonary resuscitation; chest compression; chest injury; extracorporeal cardiopulmonary resuscitation