Abstract
Cardiac injuries caused by sternal bone fragments following chest compression in CPR are rare and reported only in autopsy series. We report a case of right coronary artery (RCA) laceration caused by this mechanism. A 59-year-old man presented with chest pain. Electrocardiogram showed ST elevation in anterior leads and he underwent percutaneous coronary intervention to the left anterior descending coronary artery (LAD). In the catheter lab, he went into ventricular fibrillation and cardiac arrest, which required cardiopulmonary resuscitation with chest compression and introduction of PCPS. Repeated coronary angiogram showed posterior deviation of the RCA. Cardiac echo showed massive pericardial effusion. Intrapericardial hematoma and cardiac tamponade was suspected and treated by pericardiocentesis and subsequent emergency exploration through a median sternotomy. Intraoperative findings showed a laceration in the RCA by a sternal bone fragment, which required suture closure of the laceration and aorto-saphenous vein coronary artery bypass grafting distal to the laceration, as well as to the LAD. He was weaned off PCPS on postoperative day 2 and was discharged on postoperative day 17 without complications and neurological deficits.
