Diaphragmatic Injury Caused by Chest Compressions in a Case of Out-of-Hospital Cardiac Arrest

Abstract

While complications of cardiopulmonary resuscitation (CPR) have occasionally been described, there have been no reports yet of diaphragmatic injury occurring during CPR. Herein, we report a case of out-of-hospital cardiac arrest who was brought to the hospital with diaphragmatic injury, presumably caused by the chest compressions during CPR. An ambulance call was received for the patient, an 80-year-old man, after he collapsed at a cheap rooming house. When the emergency crew reached the patient, pulseless electrical activity (PEA) was recorded and CPR was started. Return of spontaneous circulation (ROSC) was initially achieved in the ambulance, but upon arrival at the hospital, only PEA could be recorded again. Therefore, the CPR was restarted, and ROSC was obtained. CT revealed multiple costochondral fractures on the right side, diaphragmatic injury, pneumothorax, and pneumoperitoneum. Despite thoracic drainage and intensive care management, the patient eventually died of cerebral edema. Chest compressions during CPR mainly cause injuries of the chest cage, particularly rib and sternal fractures. Our patient reported here also developed diaphragmatic injury, presumably caused by the costochondral fractures. We would like to emphasize here that a reduced incidence of the complications of CPR and consequently, an improved prognosis, can be obtained if CPR is administered in conformity with the Resuscitation Guidelines 2015.