Considerations on Liver Injuries Caused by CPR Case Presentation
DOI:
https://doi.org/10.17986/blm.2015210947Keywords:
cpr, liver injury, deathAbstract
Cardiac arrest is a life-threatening condition which requires fast maneuvers for saving the victim’s life. Cardio-pulmonary resuscitation (CPR) is one of the easiest and handiest maneuver which proved many times to be savior even though sometimes it could worsen the victim’s prognosis. In this paper the authors present the case of a 75-year old male, with a significant medical history and long term thrombolytic treatment who suffered a witnessed cardiac arrest. The emergency team who arrived at the victim’s home initiated the CPR and transported him to the hospital. The electrocardiogram showed inferior-lateral acute myocardial infarction and the cardiologist in the emergency room decided to transfer him to another hospital for specialized treatment. Despite the fact that the CPR was continued in the ambulance in order to maintain the cardiac activity, the blood pressure decreased gradually and he died couple of hours later. Internal examination at the autospy revealed multiple injuries caused by the cardiac massage: rib and sternum fractures, massive intraperitoneal bleeding, liver laceration and contusion. This paper brings to the attention of the physicians the issue of the iatrogenic injuries following the CPR and the possibility for these injuries to contribute to thanatogenesis. The authors also analyze the factors influencing the quality of the life-saving procedures and the role of the pathologist in establishing the correct cause of death taking into the gravity of the CPR related injuries.
Keywords: CPR, liver injury, death
Downloads
References
Rajab TK, Pozner CN, Conrad C, Cohn LH, Schmitto JD. Technique for chest compressions in adult CPR. World J Emerg Surg 2011;6(1):41-1186. Available from: http://www.wjes.org/content/6/1/41 https://doi.org/10.1186/1749-7922-6-41. DOI: https://doi.org/10.1186/1749-7922-6-41
Hellevuo H, Sainio M, Nevalainen R, Huhtala H, Olkkola KT, Tenhunen J, et al. Deeper chest compression – More complications for cardiac arrest patients. Resuscitation 2013;84(6):760-765. Available from: http://linkinghub.elsevier.com/retrieve/pii/S030095721300141X PubMed PMID: 23474390. https://doi.org/10.1016/j.resuscitation.2013.02.015. DOI: https://doi.org/10.1016/j.resuscitation.2013.02.015
Darok M. Injuries Resulting From Resuscitation Procedures. In: Forensic Pathology Reviews. Tsokos M, editor. Vol 1. Humana Press; 2004. p. 293-303. https://doi.org/10.1007/978-1-59259-786-4_13. DOI: https://doi.org/10.1007/978-1-59259-786-4_13
Hashimoto Y, Moriya F, Furumiya J. Forensic aspects of complications resulting from cardiopulmonary resuscitation. Legal Medicine 2007;9(2):94-99. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1344622306001398 PubMed PMID: 17276125. https://doi.org/10.1016/j.legalmed.2006.11.008. DOI: https://doi.org/10.1016/j.legalmed.2006.11.008
Smekal D, Johansson J, Huzevka T, Rubertsson S. No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS™ device—A pilot study. Resuscitation 2009;80(10):1104-1107. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300957209003220 PubMed PMID: 19595496. https://doi.org/10.1016/j.resuscitation.2009.06.010. DOI: https://doi.org/10.1016/j.resuscitation.2009.06.010
Buschmann CT, Tsokos M. Frequent and rare complications of resuscitation attempts. Intensive Care Med 2009;35(3):397-404. Available from: http://link.springer.com/10.1007/s00134-008-1255-9 PubMed PMID: 18807013. https://doi.org/10.1007/s00134-008-1255-9. DOI: https://doi.org/10.1007/s00134-008-1255-9
Miller AC, Rosati SF, Suffredini AF, Schrump DS. A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries. Resuscitation 2014;85(6):724-731. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300957214000628 PubMed PMID: 24525116. https://doi.org/10.1016/j.resuscitation.2014.01.028. DOI: https://doi.org/10.1016/j.resuscitation.2014.01.028
Meron G, Kurkciyan I, Sterz F, Susani M, Domanovits H, Tobler K, et al. Cardiopulmonary resuscitation-associated major liver injury. Resuscitation 2007;75(3):445-453. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300957207002997 PubMed PMID: 17640792. https://doi.org/10.1016/j.resuscitation.2007.05.023. DOI: https://doi.org/10.1016/j.resuscitation.2007.05.023
Hoke RS, Chamberlain D. Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation 2004;63(3):327-338. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300957204002527 PubMed PMID: 15582769. https://doi.org/10.1016/j.resuscitation.2004.05.019. DOI: https://doi.org/10.1016/j.resuscitation.2004.05.019
Masahiro Natsuaki, Ayumu Yamasaki, Noritsugu Morishige, Masaru Nishimi, Masanori Okabe, Yusuke Yamamoto, Right ventricular rupture induced by cardiopulmonary resuscitation, Journal of Cardiology Cases, Volume 1, Issue 1, February 2010, Pages e42-e44, ISSN 1878-5409, https://doi.org/10.1016/j.jccase.2009.07.006.
Gil Martín FJ, Pérez Ordóñez A, Castelo Tarrio I, Morentin Campillo B. Liver laceration caused by cardiopulmonary resuscitation manoeuvres. Emergencias 2009;21(2):148-150.
Natsuaki M, Yamasaki A, Morishige N, Nishimi M, Okabe M, Yamamoto Y. Right ventricular rupture induced by cardiopulmonary resuscitation. Journal of Cardiology Cases. 2010;1:e42-e44. https://doi.org/10.1016/j.jccase.2009.07.006 DOI: https://doi.org/10.1016/j.jccase.2009.07.006
Adler SN. Massive Hepatic Hemorrhage Associated With Cardiopulmonary Resuscitation. Arch Intern Med 1983 Apr;143(4):813-814. Available from: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinte.1983.00350040203032 PubMed PMID: 6838303. https://doi.org/10.1001/archinte.1983.00350040203032. DOI: https://doi.org/10.1001/archinte.1983.00350040203032
Clark DT. Complications Following Closed-Chest Cardiac Massage. JAMA 1962 Jul;181(4):337-338. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.1962.03050300057020 PubMed PMID: 13879679. https://doi.org/10.1001/jama.1962.03050300057020. DOI: https://doi.org/10.1001/jama.1962.03050300057020
Krischer JP. Complications of cardiac resuscitation. CHEST 1987 Aug;92(2):287-291. Available from: http://journal.publications.chestnet.org/article.aspx?doi=10.1378/chest.92.2.287 PubMed PMID: 3608599. https://doi.org/10.1378/chest.92.2.287.
Ziegenfuss MD, Mullany DV. Traumatic Liver Injury Complicating Cardio-pulmonary resuscitation. The value of a major Intensive Care facility: A report of two cases. Critical care and Resuscitation 2004;6:102-104. DOI: https://doi.org/10.1016/S1441-2772(23)01853-7
Sommers MS. THE SHATTERING CONSEQUENCES OF CPR. Nursing 1992;22(7):34-42. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00152193-199207000-00013 https://doi.org/10.1097/00152193-199207000-00013. DOI: https://doi.org/10.1097/00152193-199207000-00013
Umach P, Unterdorfer H. [Massive organ injuries resulting from resuscitation measures].. Beitr Gerichtl Med 1980;38:29-32. PubMed PMID: 7458835.
Kouzu H, Hase M, Kokubu N, Nishida J, Kawamukai M, Usami Y, et al. Delayed visceral bleeding from liver injury after cardiopulmonary resuscitation.. J Emerg Med 2010 Sep;43(4):2012-8. Available from: http://toxnet.nlm.nih.gov/cgi-bin/sis/search/r?dbs+hsdb:@term+@rn+9005-49-6 PubMed PMID: 20850256. https://doi.org/10.1016/j.jemermed.2010.05.074. DOI: https://doi.org/10.1016/j.jemermed.2010.05.074
Krammer B, Steiner M, Burstein C, Voss W, Kröger JC, Zillig D, et al. [Spontaneous, massive liver hemorrhage as a complication of thrombolysis with ultra-high dose streptokinase in deep thrombophlebitis].. Vasa 1994;23(4):373-376. Available from: http://www.nlm.nih.gov/medlineplus/bleeding.html PubMed PMID: 7817622.
Pollak S, Reiter C, Stellwag-Carion C. [2-stage rupture of the liver as a complication of external heart massage].. Z Rechtsmed 1984;92(1):67-75. Available from: http://link.springer.com/10.1007/BF02116377 PubMed PMID: 6720102. https://doi.org/10.1007/BF02116377. DOI: https://doi.org/10.1007/BF02116377
Krischer JP, Fine EG, Davis JH, Nagel EL. Complications of cardiac resuscitation. CHEST 1987 Aug;92(2):287-291. Available from: http://journal.publications.chestnet.org/article.aspx?doi=10.1378/chest.92.2.287 PubMed PMID: 3608599. https://doi.org/10.1378/chest.92.2.287. DOI: https://doi.org/10.1378/chest.92.2.287
Curca GC, Dermengiu D, Ceausu M, Francisc A, Rusu MC, Hostiuc S. Cardiac lesions associated with cardiopulmonary resuscitation. RJLM 2011;19(1):1-6. Available from: http://www.rjlm.ro/?doc=1301911087 https://doi.org/10.4323/rjlm.2011.1. DOI: https://doi.org/10.4323/rjlm.2011.1
Buschmann C, Schulz T, Tsokos M, Kleber C. Emergency medicine techniques and the forensic autopsy. Forensic Sci Med Pathol 2013;9(1):48-67. Available from: http://link.springer.com/10.1007/s12024-012-9366-6 PubMed PMID: 22872361. https://doi.org/10.1007/s12024-012-9366-6. DOI: https://doi.org/10.1007/s12024-012-9366-6
Downloads
Published
Issue
Section
License
The Journal and content of this website is licensed under the terms of the Creative Commons Attribution (CC BY) License. The Creative Commons Attribution License (CC BY) allows users to copy, distribute and transmit an article, adapt the article and make commercial use of the article. The CC BY license permits commercial and non-commercial re-use of an open access article, as long as the author is properly attributed.
