Cardiopulmonary Resuscitation Complicated by Traumatic Hepatic Laceration: A Case Report and Review of Literature

Saptarshi Biswas, Allisa Alpert, Marcus Lyon, Christoph R. Kaufmann

Abstract


We present an interesting case of a 63-year-old patient who was having lunch with friends in a restaurant when, suddenly, bystanders witnessed him “seize” for 1- minute, after which he became he had a 1-minute witnessed “seizure” followed by unresponsive and pulseless. Cardiopulmonary resuscitation (CPR) was initially performed by these bystanders at the scene, and then subsequently by EMS personnel, who achieved return of spontaneous circulation (ROSC) in the field. The patient was emergently transferred to the hospital where he remained hemodynamically unstable requiring multiple pressors. Due to an acute drop in hematocrit, along with metabolic acidosis, a computed tomography (CT) scan of the abdomen and pelvis was performed. which The scan revealed a large volume of intraperitoneal hemoperitoneum which was largely attributed to CPR. The patient He underwent an exploratory laparotomy during which and the hepatic laceration was repaired and the abdomen was packed. Intraoperatively and postoperatively, the patient remained hemodynamically unstable developing multi-organ failure and requiring multiple products including fresh frozen plasma, packed red blood cells, and cryoprecipitate. Electroencephalogram (EEG) results were consistent with anoxic brain injury and the patient’s family opted for comfort care measures only and he expired the next day. Although CPR induced injuries to hepatic structures have scarcely been reported in the literature, this may underestimate their true incidence given the high mortality rate of sudden cardiac arrest requiring CPR. Our case demonstrates that intra-abdominal trauma following CPR, though rare, must needs to always be considered taken into account. and a Importantly, a high index of clinical suspicion is often necessary to make an early diagnosis of liver trauma as a potential life-threatening complication of CPR.




J Med Cases. 2017;8(3):93-97
doi: https://doi.org/10.14740/jmc2775w


Keywords


Hepatic laceration; Cardiopulmonary resuscitation; Bystander; Hemodynamic instability

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