CRCM  Vol.3 No.1 , January 2014
Gastric laceration after cardiopulmonary resuscitation: A case report
ABSTRACT


The cardiopulmonary resuscitation (CPR) persists as the best practice to maintain cerebral and coronary perfusion after cardiac arrest. Due to the chest compressions and ventilation maneuvers during resuscitation, there are common complications reported. Abdominal organs injuries occur in approximately 30% of patients, although studies show that they are under diagnosticated. The aim of this article is to report a case of massive digestive hemorrhage by gastric laceration after cardiopulmonary resuscitation, due to the event severity and rare clinic diagnostic. A 75-year-old Caucasian man suffered a sudden malaise and cardiac arrest and transferred to an Emergency Unit (EU). The set of measures recommended by Advanced Cardiac Life Support (ACLS) was performed. Despite no resistance to the passage of nasogastric survey and spontaneous healing of fresh blood exteriorization, an endoscopy showed ulcers in gastric notch with clots adhered and active blood. There was no track record of liver or gastrointestinal diseases on this patient, identifying a gastric laceration after cardiopulmonary resuscitation. The mechanism by which the gastric laceration after CPR occurred is uncertain. Nevertheless, some precipitating factors are considered such as positioning of the patient during CPR, ideal point of compressions and ventilation pressure. In conclusion, this event is rare with a hard diagnostic however that could be avoided and minimized with preventive measures.



Cite this paper
Moreira, R. , Guizilini, S. , Marcondes, N. , Colleoni, R. , Rocco, I. , Gonçalves, I. , Velloso Caluza, A. , Batista, V. and Carvalho, A. (2014) Gastric laceration after cardiopulmonary resuscitation: A case report. Case Reports in Clinical Medicine, 3, 52-56. doi: 10.4236/crcm.2014.31013.
References
[1]   Dias, L.T., Mendes, L.C.M., Mello, P.M.V.C., et al. (2006) Ruptura gástrica por reanimação cardiopulmonar: Relato de caso. Rev Bras de Terapia Intensiva, 18, 207-211.
http://dx.doi.org/10.1590/S0103-507X2006000200017

[2]   Hoke, R.S. and Chamberlain, D. (2004) Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation, 63, 327-338.
http://dx.doi.org/10.1016/j.resuscitation.2004.05.019

[3]   Martin, P.S., Jones, M.D., Maguire, S.A., et al. (2012) Increased incidence of CPR-related rib fractures in infants—Is it related to changes in CPR technique? Resuscitation, 83, Article ID: e109.
http://dx.doi.org/10.1016/j.resuscitation.2011.08.034

[4]   Kim, M.J., Park, Y.S., Kim, S.W., et al. (2013) Chest injury following cardiopulmonary resuscitation: A prospective computed tomography evaluation. Resuscitation, 84, 361-364.
http://dx.doi.org/10.1016/j.resuscitation.2012.07.011

[5]   Smekal, D., Johansson, J., Huzevka, T., et al. (2009) No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS device—A pilot study. Resuscitation, 80, 1104-1107.
http://dx.doi.org/10.1016/j.resuscitation.2009.06.010

[6]   Hahn, C.D., Choi, Y.U., Lee, D., Frizzi, J.D., et al. (2008) Pneumoperitoneum due to gastric perforation after cardiopulmonary resuscitation: Case report. American Journal of Critical Care, 17, 388-390.

[7]   Campanharo, C.R.V., Moreira, R.S.L., Batista, R.E.A., et al. (2012) Ressuscitação cardiopulmonar: novas diretrizes de atendimento. Acta Paulista de Enfermagem, 25,483.
http://dx.doi.org/10.1590/S0103-21002012000300026

[8]   Park, S.O., Shin, D.H., Baek, K.J., et al. (2013) A clinical observational study analysing the factors associated with hyperventilation during actual cardiopulmonary resuscitation in the emergency department. Resuscitation, 84, 298-303. http://dx.doi.org/10.1016/j.resuscitation.2012.07.028

[9]   Spoormans, I., Hoorenbeecka, K.V., Balliu, L. and Jorensa, P.G. (2010) Gastric perforation after cardiopulmonary resuscitation: Review of the literature. Resuscitation, 81, 272-280. http://dx.doi.org/10.1016/j.resuscitation.2009.11.023

[10]   Campillo-Soto, A., Lirón-Ruiz, R., Torralba-Martínez, J.A., et al. (2007) Rotura gástrica y neumoperitoneo masivo trás resucitación cardiopulmonar por personal no sanitário. Cirugía Española, 81, 49-51.
http://dx.doi.org/10.1016/S0009-739X(07)71258-7

[11]   Offerman, S.R., Holmes, J.F., Wisner, D.H., et al. (2001) Gastric rupture and massive pneumoperitoneum after bystander cardiopulmonary resuscitation. The Journal of Emergency Medicine, 21, 137-139.
http://dx.doi.org/10.1016/S0736-4679(01)00357-2

[12]   Haslam, N., Campbell, G.C., Duggan, J.E., et al. (2004) Gastric rupture associated with use of laryngeal mask airway during cardiopulmonary resuscitation. British Medical Journal, 329, 125-126.
http://dx.doi.org/10.1136/bmj.329.7476.1225

[13]   American Heart Association (2010) Highlights of the 2010 AHA guidelines for CPR and ECC. Circulation.
http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf

[14]   Neumar, R.W. (2010) Part 8: Adult Advanced cardiovascular life support: 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122, S729-S767.
http://dx.doi.org/10.1161/CIRCULATIONAHA.110.970988

[15]   Smally, A.J., Ross, M.J., Huot, C.P., et al. (2002) Gastric rupture following bag-valve-mask ventilation. The Journal of Medicine, 22, 27-29.

 
 
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