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Review
. 2024 Apr 24;13(9):2498.
doi: 10.3390/jcm13092498.

Acute Lung Injury after Cardiopulmonary Resuscitation: A Narrative Review

Giuseppe Marchese  1 , Elisabetta Bungaro  2   3 , Aurora Magliocca  2 , Francesca Fumagalli  4 , Giulia Merigo  3   5 , Federico Semeraro  6 , Elisa Mereto  2   3 , Giovanni Babini  3 , Erik Roman-Pognuz  7 , Giuseppe Stirparo  8 , Alberto Cucino  9 , Giuseppe Ristagno  2   3
Affiliations
Review

Acute Lung Injury after Cardiopulmonary Resuscitation: A Narrative Review

Giuseppe Marchese et al. J Clin Med. .

Abstract

Although cardiopulmonary resuscitation (CPR) includes lifesaving maneuvers, it might be associated with a wide spectrum of iatrogenic injuries. Among these, acute lung injury (ALI) is frequent and yields significant challenges to post-cardiac arrest recovery. Understanding the relationship between CPR and ALI is determinant for refining resuscitation techniques and improving patient outcomes. This review aims to analyze the existing literature on ALI following CPR, emphasizing prevalence, clinical implications, and contributing factors. The review seeks to elucidate the pathogenesis of ALI in the context of CPR, assess the efficacy of CPR techniques and ventilation strategies, and explore their impact on post-cardiac arrest outcomes. CPR-related injuries, ranging from skeletal fractures to severe internal organ damage, underscore the complexity of managing post-cardiac arrest patients. Chest compression, particularly when prolonged and vigorous, i.e., mechanical compression, appears to be a crucial factor contributing to ALI, with the concept of cardiopulmonary resuscitation-associated lung edema (CRALE) gaining prominence. Ventilation strategies during CPR and post-cardiac arrest syndrome also play pivotal roles in ALI development. The recognition of CPR-related lung injuries, especially CRALE and ALI, highlights the need for research on optimizing CPR techniques and tailoring ventilation strategies during and after resuscitation.

Keywords: cardiac arrest; cardiopulmonary resuscitation; lung edema; lung injury.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Representative computed tomographic images of lung injuries following cardiopulmonary resuscitation: (A,B) cranial and (C) caudal lung lobes of pigs with cardiopulmonary resuscitation-associated lung edema (CRALE); (D) right pneumothorax with left rib fracture; (E) bilateral pneumothorax; (F) bilateral pneumothorax with right hemothorax.
Figure 2
Figure 2
Cardiopulmonary resuscitation-associated lung edema. Crs, respiratory system compliance; EELV, end-expiratory lung volume; HU, Hounsfield unit; PaO2/FiO2, oxygen arterial partial pressure/oxygen inspiratory fraction; Rrs, respiratory system resistance; VD/Vt, dead space fraction.
See this image and copyright information in PMC

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