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Case Reports
. 2018 Aug 28:6:54.
doi: 10.1186/s40560-018-0325-5. eCollection 2018.

Pericardial injury from chest compression: a case report of incidental release of cardiac tamponade

Affiliations
Case Reports

Pericardial injury from chest compression: a case report of incidental release of cardiac tamponade

Shigeaki Aoyagi et al. J Intensive Care. .

Abstract

Background: Although chest compression is a standard technique in cardiopulmonary resuscitation, it is well recognized that manual chest compression causes various internal injuries, of which major injuries are often fatal. Similarly, when cardiac tamponade occurs in patients with type A acute aortic dissection, many patients die before reaching the hospital. We report a rare case in which chest compressions caused pericardial laceration that may have inadvertently played a life-saving role in releasing cardiac tamponade induced by acute aortic dissection.

Case presentation: A 67-year-old woman developed cardiac arrest soon after complaining of epigastric pain, and after successful resuscitation by manual chest compression, she was transferred to our hospital. On arrival, the patient was 14 on the Glasgow Coma Scale. An ECG showed a normal sinus rhythm, and no arrhythmias or signs of myocardial ischemia were observed. A chest X-ray revealed left pleural effusion, while cardiomegaly and pneumothorax were not identified. Computed tomography revealed type A aortic dissection, mild pericardial effusion, and massive left pleural effusion. No pulmonary embolus was found on the CT. After drainage of bloody effusion from the left pleural space, an emergency operation was begun. During surgery, a pericardial laceration with communication to the left pleural space and a hemothorax were found; however, no cardiac injury was identified. No other intra-thoracic injuries or rupture of the aortic dissection causing the hemothorax were detected. Hemiarch replacement was performed without difficulty, but the patient died of multi-organ failure 30 days after surgery.

Conclusions: We report a case of pericardial injury without skeletal fracture caused by chest compression. The pericardial laceration may have inadvertently served to release the cardiac tamponade induced by the acute aortic dissection, resulting in the hemothorax, and provided time to receive surgery.

Keywords: Aortic dissection; Cardiac tamponade; Cardiopulmonary arrest; Cardiopulmonary resuscitation; Chest compression; Pericardial injury.

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Conflict of interest statement

The current study was approved by our Institutional Research Ethics Board at The St. Mary’s Hospital (17-0103).A written informed consent was obtained from the patient and her family for publication of this case report and any accompanying images.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Preoperative CTs. CTs showing thrombosed type A aortic dissection with ulcer-like projection in the proximal ascending aorta, massive left pleural effusion (a), and mild pericardial effusion (b)
Fig. 2
Fig. 2
Intraoperative photograph. Photograph showing the large laceration (arrows) of the pericardium at the phrenico-pleural junction communicating to the left pleural space. RV right ventricle

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