Atraumatic Polycompartment Syndrome Secondary to Cardiogenic Shock: A Case Report

Abstract

We report the case of a 53-year-old male who developed polycompartment syndrome (PCS) secondary to cardiogenic shock. After suffering a cardiac arrest, a self-perpetuating cycle of intra-abdominal hypertension (IAH) and vital organ damage led to abdominal compartment syndrome (AbCS), which then contributed to the precipitation of extremity compartment syndrome (CS) in bilateral thighs, legs, forearms, and hands. This report is followed by a review of the literature regarding the pathophysiology of this rare sequela of cardiogenic shock. While the progression from cardiogenic shock to AbCS and ultimately to PCS has been hypothesized, no prior case reports demonstrate this. Furthermore, this case suggests more generally that IAH may be a risk factor for extremity CS. Future studies should examine the potential interplay between IAH and extremity CS in patients at risk, such as polytrauma patients with tibial fractures.

Keywords: abdominal compartment syndrome; cardiogenic shock; compartment syndrome; intraabdominal hypertension; polycompartment syndrome.

Figure 1. Brain magnetic resonance imaging shows areas of restricted diffusion scattered throughout the cortex (arrow 1), subcortical white matter (arrow 2), periventricular white matter (arrow 3), deep gray matter (arrow 4), and cerebellum (arrow 5). These likely represent a combination of watershed and ischemic infarction

Figure 2. An illustration of the combination of cardiogenic shock and massive fluid resuscitation in our patient that kicked off a vicious cycle of increasing pressures and acidosis affecting vital organ function throughout the body.

Figure created by authors using BioRender (Science Suite Inc., Toronto, ON, CA)