Miyatani Kazuki, Takeuchi Ikuto, Fujita Wataru, Yanagawa Youichi
Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan.
J Emerg Trauma Shock. 2023 Apr-Jun;16(2):68-70. doi: 10.4103/jets.jets_128_22. Epub 2023 Feb 24.
The patient was an 80-year-old woman with chronic atrial fibrillation, chronic heart failure, cerebellar infarction, hyperlipidemia, and hypertension, who suddenly collapsed while playing gateball outdoors. The doctor at a nearby clinic doctor found her in a state of cardiopulmonary arrest and started basic life support. Twelve minutes after discovery, spontaneous circulation returned. On arrival, she was in a deep coma state with atrial fibrillation-related tachycardia. A physical examination revealed pulseless right radial and left popliteal arteries with cyanosis. Whole-body-enhanced computed tomography and head magnetic resonance imaging demonstrated multiple ischemic organs. Taken together, it was considered that a massive-free thrombus from the left atrium, which was caused by atrial fibrillation, had first obstructed the left ventricular outflow tract, resulting in cardiac arrest. Then, the thrombus had been scattered throughout the body by chest compression. Her condition was judged to be irreversible and she died on day 3. This is the first reported case of multiple systemic embolization associated with chest compression in a patient with cardiac arrest. This unique case adds one more cause to the list of the documented etiologies of complications caused by chest compression.
患者为一名80岁女性，患有慢性心房颤动、慢性心力衰竭、小脑梗死、高脂血症和高血压，在户外打门球时突然晕倒。附近诊所的医生发现她处于心肺骤停状态，遂开始进行基本生命支持。发现12分钟后，自主循环恢复。送达时，她处于深度昏迷状态，伴有与心房颤动相关的心动过速。体格检查发现右侧桡动脉和左侧腘动脉无脉搏且皮肤发绀。全身增强计算机断层扫描和头部磁共振成像显示多个器官存在缺血。综合判断，认为是心房颤动导致左心房形成巨大游离血栓，该血栓首先阻塞左心室流出道，导致心脏骤停。随后，血栓通过胸外按压扩散至全身。她的病情被判定为不可逆转，于第3天死亡。这是首例报告的心脏骤停患者因胸外按压导致多发系统性栓塞的病例。这一独特病例为胸外按压所致并发症的已记录病因清单增添了又一个病因。
