(1411) Liver Laceration Secondary to Chest Compression: A Grave Cardiopulmonary Resuscitation Complication

Introduction: Sudden cardiac arrest affects over 600,000 people in the USA. Timely and effective cardiopulmonary resuscitation (CPR) is very important for the return of spontaneous circulation (ROSC). Iatrogenic complication of CPR should also be considered in post arrest care. More data is needed to increase awareness of post CPR complications. Here we report a case of a rare finding of liver laceration post CPR which resulted in hemorrhagic shock.

Description: A 51-year-old woman was brought to the emergency department for evaluation following a witnessed syncopal episode at home. She had cardiac arrest in the field, ROSC was achieved after 3 minutes of CPR. On arrival, she was hypoxic, hypotensive and tachycardic (sinus rhythm). Shortly after intubation, she coded again requiring CPR. CT scan of the chest showed sub massive PE in bilateral lower lobes. She underwent emergent mechanical thrombectomy, placed on heparin infusion, and was admitted to the ICU.

She was on multiple pressors. Bedside echo showed no significant right ventricular dysfunction to explain persistent hypotension. Abdominal ultrasound revealed a large amount of free fluid in her abdomen which prompted immediate discontinuation of heparin and reversal with protamine. Massive blood transfusion protocol was initiated. Urgent CTA confirmed massive intra-abdominal hemorrhage. Closer review of imaging obtained during the initial CT study demonstrated mild active abdominal bleeding. An unintended consequence of CPR, liver laceration caused bleeding which was further exacerbated by anticoagulation with heparin infusion. Once heparin was discontinued and reversed, serial imaging confirmed no further bleeding from the laceration. She appropriately responded to resuscitation and successfully weaned off all pressors. Shortly after being transferred out of the ICU, she was able to be safely discharged home.

Discussion: CPR-induced complications such as visceral or arterial laceration can be lethal. In the event of unexpected post-resuscitation shock, the differential must include hemoperitoneum or hemothorax, especially in the setting of active anticoagulation. Effective utilization of serial bedside ultrasound exam allows for immediate evaluation and earlier opportunity for life-saving intervention.