Liver Injury Associated with Chest Compression in Cardiopulmonary Arrest Patients

Introduction: Although chest compression is an effective emergency maneuver for cardiopulmonary arrest (CPA), it carries the risk of complications such as rib fracture, sternal fracture, and organ injury. Methods: We summarized thirteen case reports of CPA patients presenting with liver injury associated with CPR including chest compression reported between 1993 and 2015 in Japan. Five were male and eight were female; their ages ranged from 31 to 83 years old. Unfractionated heparin was administered to ten patients as a treatment for embolism or indication of veno-arterial extra corporeal membrane oxygenation (VA-ECMO). Twelve cases survived surgery or non-surgical management, but one could not survive with non-surgical management. Case: Two cases of CPA due to pulmonary thromboembolism were admitted to our department. Spontaneous circulation was restored due to cardiopulmonary resuscitation (CPR), including chest compression. After use of an anticoagulant drug and indication of VA-ECMO, contrast-enhanced computed tomography (CE-CT) revealed infra-diaphragmatic liver injury in both cases. One patient could survive with damage control surgery (DCS), while the other patient could not survive with non-surgical management. Conclusion: Patients with hemorrhagic diathesis are at critical risk for complications from chest compression. Aggressive treatments, including DCS, might be effective, even for patients treated with anticoagulant drugs.