Etuk Aniekeme S, Adeniran Olanrewaju F, Nkwocha Bernard I, Asangmbeng Nformbuh, Jacob Mina
Internal Medicine, Thomas Hospital Infirmary Health, Fairhope, USA.
Internal Medicine, West Virginia University School of Medicine, Morgantown, USA.
Cureus. 2023 Jun 27;15(6):e41027. doi: 10.7759/cureus.41027. eCollection 2023 Jun.
Aortic dissection is characterized by a tear or rupture in the intimal layer of the aorta causing blood to flow between the layers of the arterial wall, thus separating them. While cardiopulmonary resuscitation (CPR) is a life-saving intervention, it can unintentionally contribute to the development or worsening of aortic dissection. The forceful chest compressions involved in CPR can put significant pressure on the fragile aortic wall, potentially leading to a tear or rupture. This highlights the delicate balance between life-saving measures and the potential risks they carry. Though studies have been done on the effects of CPR on the thoracic wall, few reports have studied the effects on the structures that lie in the thoracic cavity. The authors present a 63-year-old with a history of thoracic aneurysm repair who experienced a cardiac arrest while choking on food at home. The patient received CPR and a CT scan done thereafter revealed thoracic dissection and rupture. The patient received medical management in the Intensive Care Unit but eventually expired due to irreversible neurological damage. This highlights the importance of recognizing that CPR can pose a risk for aortic dissection and rupture, particularly in individuals with prior aortic repairs. It emphasizes the need for developing protocols to monitor patients who have undergone aneurysmal repair and adjusting CPR techniques to suit their specific needs. Additionally, further studies are needed to understand how often aortic complications occur after CPR and to provide guidance for follow-up care in patients who have had aortic repairs. By implementing these measures, we can improve outcomes and safety during resuscitation.
主动脉夹层的特征是主动脉内膜层出现撕裂或破裂，导致血液在动脉壁各层之间流动，从而使各层分离。虽然心肺复苏（CPR）是一种挽救生命的干预措施，但它可能无意中促使主动脉夹层的发生或恶化。心肺复苏中涉及的强力胸外按压会对脆弱的主动脉壁施加巨大压力，有可能导致撕裂或破裂。这凸显了挽救生命措施与其所带来的潜在风险之间的微妙平衡。尽管已经有关于心肺复苏对胸壁影响的研究，但很少有报告研究其对胸腔内结构的影响。作者报告了一名63岁有胸主动脉瘤修复病史的患者，该患者在家中进食时噎食导致心脏骤停。患者接受了心肺复苏，随后进行的CT扫描显示有胸主动脉夹层和破裂。患者在重症监护病房接受了药物治疗，但最终因不可逆转的神经损伤而死亡。这凸显了认识到心肺复苏可能给主动脉夹层和破裂带来风险的重要性，尤其是在有主动脉修复史的个体中。它强调了制定方案以监测接受过动脉瘤修复的患者并调整心肺复苏技术以满足其特定需求的必要性。此外，还需要进一步研究以了解心肺复苏后主动脉并发症的发生频率，并为接受过主动脉修复的患者的后续护理提供指导。通过实施这些措施，我们可以改善复苏过程中的结果和安全性。
