Ruptured subcapsular liver haematoma following mechanically-assisted cardiopulmonary resuscitation

Subcapsular Hepatic Hematoma after Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is an important life-saving procedure in emergency care. However, CPR is associated with various complications. A 41-year-old man was admitted to the intensive care unit after CPR. A sudden decrease in the blood pressure and hematocrit level was recorded. An abdominal computed tomography (CT) showed a large subcapsular hematoma in the left lobe of the liver. With conservative treatment, the hematoma reduced in size, but it was later managed with percutaneous drainage. The patient recovered and was discharged. We obtained a favorable outcome with conservative, nonsurgical treatment. Subcapsular hepatic hematoma is a potential life-threatening complication that should be considered in CPR survivors.

Pulmonary emboli cardiac arrest with CPR complication: Liver laceration and massive abdominal bleed, a case report

INTRODUCTION

Massive pulmonary emboli may cause right ventricular failure and backward stasis with parenchymal organ swelling thus increasing the risk for laceration, e.g. if CPR is needed.

PRESENTATION OF CASE

A 28-year-old Colombian female with no medical history but taking contraceptive pills and having had a recent longer flight was admitted to Danderyds hospital Emergency Department because of respiratory failure. She developed cardiac arrest in the emergence department following the emergent diagnosis of pulmonary emboli. Cardio-pulmonary resuscitation was initiated, initially with manual and subsequent mechanical compressions with a so called LUCAS device. Patients did not respond properly to the CPR and showed signs of hypovolemia. Emergent ultrasound raised suspicion of abdominal bleed. Emergent laparotomy confirmed liver laceration and massive haemorrhage.

CONCLUSION

Pulmonary emboli with subsequent right ventricular failure may cause backwards stasis, and parenchymal organ e.g. liver enlargement. The risk for laceration injuries and internal bleed must be acknowledged when applying external forces as in case of cardiac arrest and need for resuscitation. Frequent and vigilant control of positioning of manual as well as mechanical compressions is of importance.