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Haj-Yahia S, Al Aqra A, Abed K, Bali K, Sbaih MN, Al Asmar M, Caputo M, Othman W, Al-Adhami A. Rare case of diaphragmatic rupture following resuscitation in a pregnant woman first in literature. J Cardiothorac Surg 2020; 15:44. [PMID: 32103768 PMCID: PMC7045579 DOI: 10.1186/s13019-020-1090-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Complications following Cardiopulmonary resuscitation (CPR) are rare and usually follows a vigorous CPR or in special cases like pregnancy are due to lack of knowledge and clinical practice of how to preform CPR in pregnancy. One of this complication is diaphragmatic rupture with herniation of abdominal organs. Surgical intervention needs to be planned carefully in multidisciplinary team approach and requires fine surgical techniques for better outcome. There are few reported cases of diaphragmatic rupture after Cardiopulmonary resuscitation but none in pregnant woman. CASE PRESENTATION We report a rare case of diaphragmatic rupture in a 29-year-old pregnant patient who experienced a full-blown diaphragmatic defect and herniation of the abdominal organs into the thoracic cavity, as a complication of CPR. Following careful assessment and diagnosis, the patient underwent urgent laparotomy with reduction of the contents and primary closure of the defect. One year follow up was satisfactory. To the best of our knowledge, this is the first reported case of diaphragmatic rupture with herniation of the abdominal organs following CPR in a pregnant woman in the literature. CONCLUSION The application of external cardiac massage through CPR is a life-saving procedure for the management of cardiac arrest. Common complications related to CPR include rib fractures, sternal fractures and haemothorax. Diaphragmatic rupture with herniation of the abdominal organs is a rare complication, having been reported only once in the literature (Sabzi F, Faraji R, Tanaffos 16:170-172, 2017); however, it represents a serious and life-threating event. Thus, careful evaluation of the patient by a multidisciplinary team and prompt intervention is recommended in order to improve outcomes.
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Affiliation(s)
- Saleem Haj-Yahia
- Cardiothoracic and Transplant Surgery, School of Clinical Sciences, Bristol Royal Infirmary, University of Bristol, Upper Maudlin StreetBS2 8HW, Bristol, UK. .,Cardiothoracic and Transplant Surgery, Cardiovascular & Medical Sciences, British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G128TA, UK.
| | - Amro Al Aqra
- Cardiothoracic Surgery, An-Najah National University Teaching Hospital, The National Heart and Lung Institute, Nablus, Palestine
| | - Kamal Abed
- Pediatric Surgery Unit, An-Najah National University Teaching Hospital, Nablus, Palestine.,Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | - Khalil Bali
- Cardiothoracic Surgery, An-Najah National University Teaching Hospital, The National Heart and Lung Institute, Nablus, Palestine
| | - Mohammad N Sbaih
- Cardiothoracic Surgery, An-Najah National University Teaching Hospital, The National Heart and Lung Institute, Nablus, Palestine
| | - Mohanad Al Asmar
- Cardiothoracic Surgery, An-Najah National University Teaching Hospital, The National Heart and Lung Institute, Nablus, Palestine
| | - Massimo Caputo
- Pediatric Cardiac Surgery, British Heart Foundation Chair, University of Bristol, Bristol, UK
| | - Wafiq Othman
- Cardiac Intensive Care, An-Najah National University Teaching Hospital, Nablus, Palestine.,Anesthesia Department, An-Najah National University Teaching Hospital, Nablus, Palestine
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Hillman SL, Cooper NC, Siassakos D. Born to survive: A critical review of out-of-hospital maternal cardiac arrests and pre-hospital perimortem caesarean section. Resuscitation 2019; 135:224-225. [PMID: 30599181 DOI: 10.1016/j.resuscitation.2018.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Affiliation(s)
- S L Hillman
- University College London & University College Hospital, EGA Wing, 25 Grafton Way, London WC1E 6DB, United Kingdom
| | - N C Cooper
- University College London & University College Hospital, EGA Wing, 25 Grafton Way, London WC1E 6DB, United Kingdom
| | - D Siassakos
- University College London & University College Hospital, EGA Wing, 25 Grafton Way, London WC1E 6DB, United Kingdom.
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Maurin O, Lemoine S, Jost D, Lanoë V, Renard A, Travers S, Lapostolle F, Tourtier JP. Maternal out-of-hospital cardiac arrest: A retrospective observational study. Resuscitation 2018; 135:205-211. [PMID: 30562597 DOI: 10.1016/j.resuscitation.2018.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 11/19/2022]
Abstract
AIM Out-of-hospital cardiac arrests (OHCAs) in pregnant women are rare events. In this study, we aimed to describe a cohort of pregnant women who experienced OHCAs in a large urban area, and received treatment by the prehospital teams in a two-tiered emergency response system. METHODS This retrospective study included pregnant women over 18 years of age who experienced OHCAs. The analysed variables included maternal age, gestational age, variables specific to the rescue system, number of shocks delivered by an automatic external defibrillator, and rates of maternal and neonatal survival. RESULTS Over the 5-year study period, 19,515 OHCAs occurred, 16 of which were in pregnant women. These 16 patients had a median age of 31 years [interquartile range (IQR): 28-35] and a median gestational age of 20 weeks [IQR: 10-33]. Three patients (18.8%) had an initial rhythm of ventricular fibrillation. Only one patient underwent thrombolysis. Of the 16 patients, 6 (38%) died after resuscitation on the scene. The remaining 10 were transported to the hospital, of whom 5 achieved circulation through a mechanical CPR device. Only 2 patients were alive 30days after OHCA. CONCLUSIONS Over half of the pregnant women who experienced OHCA were at least 20 weeks pregnant. Analysis of the prehospital medical data suggests that the current recommendations are difficult to apply in an out-of-hospital environment. Specific recommendations for this situation must be developed.
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Affiliation(s)
- Olga Maurin
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, Paris, France.
| | - Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France; Sudden Death Expertise Center (SDEC), INSERM U970, Paris, France
| | - Vincent Lanoë
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Aurelien Renard
- Military Teaching Hospital, HIA Sainte Anne, Emergency Department, Toulon, France
| | | | - Frederic Lapostolle
- AP-HP, Emergency Medical Service Department (SAMU) 93, Avicenne Hospital, INSERM U942, Bobigny, France
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Cox TR, Crimmins SD, Shannon AM, Atkins KL, Tesoriero R, Malinow AM. Liver lacerations as a complication of CPR during pregnancy. Resuscitation 2017; 122:121-125. [PMID: 29097198 DOI: 10.1016/j.resuscitation.2017.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 11/26/2022]
Abstract
AIM Cardiac arrest in peripartum patients is a rare but devastating event; reported rates in the literature range from 0.019% to 0.0085%. In the general population, a well-described complication of cardiopulmonary resuscitation (CPR), liver laceration and injury, is reported at a rate of between 0.5-2.9% after CPR. Liver laceration rate among peripartum patients receiving CPR has not been well-studied. We sought to find the rate of liver lacerations in the peripartum population associated with CPR, with the hypothesis that the rate would be higher than in the general population. METHODS We identified pregnancies complicated by cardiac arrest by performing a retrospective medical record review from 2011 to 2016 at a single tertiary referral hospital. We then compared the rate of liver lacerations in this group to the rate in the general population as found in the literature. RESULTS Eleven of 9408 women in the peripartum period suffered cardiac arrest. Return of spontaneous circulation occurred in seven of eleven (64%) women. Three of these seven women suffered clinically significant liver laceration (43%). Overall mortality rate among women suffering cardiac arrest was 82% (9/11).Even after return of spontaneous circulation, the mortality rate was 72%(5/7) including two of three women suffering liver laceration. CONCLUSIONS Based on a small retrospective study, liver lacerations requiring intervention occurred in 43% of gravidas patients that survived CPR, and is significantly higher than published rates (0.6-2.1%) for the general patient population. Further studies are indicated to determine the incidence of liver injury after peripartum CPR.
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Affiliation(s)
- Timothy R Cox
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Sarah D Crimmins
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Allison M Shannon
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kristin L Atkins
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Howard University School of Medicine, Washington, D.C., United States
| | - Ronald Tesoriero
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Andrew M Malinow
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, United States
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