Lee Jeong-Sun, Hong Suk-Kyung
Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Crit Care Med. 2017 May;32(2):218-222. doi: 10.4266/kjccm.2016.00416. Epub 2016 Dec 29.
We describe a case of traumatic aortic dissection associated with cardiac compression in a patient with anaphylactic cardiac arrest who underwent cardiopulmonary resuscitation (CPR). A 54-year-old man who was scheduled to undergo surgery for gastric cancer went into cardiac arrest caused by an anaphylactic reaction to prophylactic antibiotics in the operating room. Veno-arterial extracorporeal membrane oxygenation (ECMO) was performed. CPR, including chest compressions, was performed for 35 minutes, and the patient was transferred to the intensive care unit (ICU) after spontaneous circulation returned. The patient received ECMO for 9 hours until confirmation of normal cardiac function on transthoracic echocardiography (TTE). Twenty days after cardiac arrest, an aortic dissection and fractures in the left fourth and fifth ribs due to chest compression were detected by abdominal computed tomography. The DeBakey type III aortic dissection extended from the distal arch of the thoracic aorta to the proximal level of the renal artery, involving the celiac trunk. It was considered an uncomplicated type B aortic dissection with no sign of malperfusion of the major vessels. This case demonstrates the potential traumatic injuries that can occur after CPR and encourages proper management of mechanical complications in cardiac arrest survivors.
我们描述了一例在接受心肺复苏(CPR)的过敏性心脏骤停患者中发生的创伤性主动脉夹层伴心脏受压的病例。一名计划接受胃癌手术的54岁男性在手术室因对预防性抗生素发生过敏反应而心脏骤停。进行了静脉-动脉体外膜肺氧合(ECMO)。包括胸外按压在内的心肺复苏进行了35分钟,自主循环恢复后患者被转入重症监护病房(ICU)。患者接受了9小时的ECMO治疗,直到经胸超声心动图(TTE)确认心脏功能正常。心脏骤停20天后,腹部计算机断层扫描检测到因胸外按压导致的主动脉夹层以及左侧第四和第五肋骨骨折。DeBakey III型主动脉夹层从胸主动脉远端弓部延伸至肾动脉近端水平,累及腹腔干。它被认为是一种无并发症的B型主动脉夹层,主要血管无灌注不良迹象。该病例展示了心肺复苏后可能发生的潜在创伤性损伤,并促使对心脏骤停幸存者的机械并发症进行妥善管理。