Korean J Crit Care Med.  2017 May;32(2):218-222. 10.4266/kjccm.2016.00416.

Aortic Dissection in a Survivor after Cardiopulmonary Resuscitation

• Lee JS
• Hong SK

• KMID: 2384048
• DOI: http://doi.org/10.4266/kjccm.2016.00416

Abstract

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. 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.

Keyword

aortic dissection; cardiopulmonary resuscitation; computed tomography, spiral

MeSH Terms

Anaphylaxis
Anti-Bacterial Agents
Aorta, Thoracic
Cardiopulmonary Resuscitation*
Echocardiography
Extracorporeal Membrane Oxygenation
Heart Arrest
Humans
Intensive Care Units
Middle Aged
Operating Rooms
Renal Artery
Ribs
Stomach Neoplasms
Survivors*
Thorax
Tomography, Spiral Computed
Anti-Bacterial Agents

Figure

• 

  Figure 1. Anteroposterior chest radiography performed after cardiopulmonary resuscitation. (A) Initial chest radiography in the ICU shows diffuse pulmonary edema and subsegmental atelectasis in the left lower lung field. (B) Follow-up chest radiography performed after 6 hours reveals that pulmonary edema was improved due to the improvement in cardiac function. ICU: intensive care unit.

• 

  Figure 2. Aortic dissection after cardiopulmonary resuscitation. (A) Transverse contrast-enhanced computed tomography (CT) image shows dissection and saccular aneurysm of the proximal descending aorta and associated fracture of the left rib. (B) Transverse view at the abdominal level shows aortic dissection involvement of the celiac trunk; however, there is no malperfusion of the peripheral organs and periaortic hematoma. (C) Sagittal view of the contrast-enhanced CT image shows that the aortic dissection extends from the distal arch of the thoracic aorta to the proximal level of the renal artery.

Reference

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