A Case of Liver Injury with Hemorrhagic Shock due to Chest Compression at Cardiopulmonary Resuscitation

Abstract

A 71-year-old man who developed cardiac arrest (initial rhythm : ventricular fibrillation) underwent cardiopulmonary resuscitation (CPR) performed by emergency medical paramedics and regained spontaneous circulation approximately 29 minutes after collapse. Emergency coronary angiography revealed a normal coronary artery, and the administration of anticoagulant and antiplatelet drugs was initiated. A plain thoracoabdominal computed tomography (CT) scan on ICU admission revealed no findings suggestive of organ injury. However, 9 hours after admission, his hemodynamic state suddenly worsened and an echography revealed fluid retention in the abdomen. An enhanced CT scan showed intra-abdominal hemorrhage and liver injury with extravasation of contrast medium. Transcatheter arterial embolization was performed with the diagnosis of liver injury complicated with chest compression, his hemodynamic state became stable, and he was transferred to another hospital on hospital day 17 without neurogenic disorder. Liver injury complicated with chest compression is rare, but diagnosis is difficult at the patient's first visit and occasionally late and sudden worsening of hemodynamic state can occur that demands urgent hemostasis. When hemodynamics becomes unstable with a decrease of hemoglobin value, enhanced CT should be performed early considering a possibility of liver injury complicated with chest compression.