Delayed Visceral Bleeding from Liver Injury After Cardiopulmonary Resuscitation

Abstract Background Visceral injury is a life-threatening complication of cardiopulmonary resuscitation (CPR); however, the clinical significance has been masked by the lethal outcome of out-of-hospital cardiac arrest (OHCA). Objective The objective is to share our experience of successful treatment...

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Bibliographic Details
Published in:The Journal of emergency medicine 2012-10, Vol.43 (4), p.e245-e248
Main Authors: Kouzu, Hidemichi, MD, Hase, Mamoru, MD, Kokubu, Nobuaki, MD, Nishida, Junichi, MD, Kawamukai, Mina, MD, Usami, Yoko, MD, Hirokawa, Naoki, MD, Meguro, Makoto, MD, Tsuchihashi, Kazufumi, MD, Miura, Tetsuji, MD, Asai, Yasufumi, MD, Shimamoto, Kazuaki, MD
Format: Article
Language:English
Subjects:
Anticoagulants - adverse effects
cardiac arrest
cardiopulmonary resuscitation
Cardiopulmonary Resuscitation - adverse effects
Chemical and Drug Induced Liver Injury - etiology
Chemical and Drug Induced Liver Injury - surgery
Chemical and Drug Induced Liver Injury - therapy
Embolization, Therapeutic
Emergency
Hemodynamics
Hemorrhage - etiology
Hemorrhage - surgery
Hemorrhage - therapy
Heparin - adverse effects
heparinization
Humans
liver injury
Male
mechanical circulatory support
Middle Aged
Out-of-Hospital Cardiac Arrest - therapy
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Summary:Abstract Background Visceral injury is a life-threatening complication of cardiopulmonary resuscitation (CPR); however, the clinical significance has been masked by the lethal outcome of out-of-hospital cardiac arrest (OHCA). Objective The objective is to share our experience of successful treatment of OHCA patients with serious, CPR-related visceral complications. Case Reports We report two cases of cardiac-origin OHCA with liver injury exacerbated by heparinization during mechanical circulatory support. Although both patients presented with delayed massive liver bleeding (intrahepatic or peritoneal) that compromised hemodynamic status, one patient was successfully treated by selective transcatheter arterial embolization and the other by a surgical procedure. Conclusion Preventive measures such as careful CPR, as well as interventional or surgical repair after the early diagnosis of visceral injury, are required to improve the outcome in some cases of OHCA.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2010.05.074