Background and Objectives: Liver injury is a rare complication of cardiopulmonary resuscitation. Correct and early diagnosis and treatment are essential. The clinical signs of injury may be masked by the cardiac arrest. We present a single-centre retrospective observational study of traumatic liver injury after cardiopulmonary resuscitation. Materials and Methods: A retrospective analysis of the patients treated for liver injury after cardiopulmonary resuscitation was conducted. Demographic data, the cause of resuscitation, the duration of restoration of spontaneous circulation (ROSC), and the surgical approach were analysed. Results: We have treated nine patients with severe liver injury after cardiopulmonary resuscitation. The diagnosis was made on the basis of cardiopulmonary instability, a fall in the erythrocyte count in eight cases, and was confirmed by CT or ultrasound examination. The last one was diagnosed accidentally on MR. Surgery, in cases of unstable patients, was followed immediately after a diagnosis. We combined liver sutures and intra-abdominal packing with a planned second-look surgery. Five of the nine patients survived. Conclusions: Liver injury after cardiopulmonary resuscitation is rare and is associated with high mortality. The recurrence of cardiopulmonary instability and/or a low or falling red blood cell count are the main signs of this injury. Bedside ultrasound and CT scans are the most important methods to confirm the diagnosis. The rule of surgical repair is the same as in all liver injuries, regardless of aetiology. The key factors for survival include early diagnosis, together with the length of restoration of spontaneous circulation (ROSC).

1st Department of Surgery General University Hospital 128 08 Prague Czech Republic

1st Medical Faculty Charles University 128 00 Prague Czech Republic

Department of Radiodiagnostics General University Hospital 128 08 Prague Czech Republic

Zobrazit více v PubMed

Engelken F.J., Bosse G., Diederichs G. A complication of cardiopulmonary resuscitation. Emerg. Med. J. 2011;28:173. doi: 10.1136/emj.2009.074393. PubMed DOI

Meron G., Kurkciyan I., Sterz F., Susani M., Domanovits H., Tobler K., Bohdjalian A., Laggner A.N. Cardiopulmonary resuscitation-associated major liver injury. Resuscitation. 2007;75:445–453. doi: 10.1016/j.resuscitation.2007.05.023. PubMed DOI

Kouzu H., Hase M., Kokubu N., Nishida J., Kawamukai M., Usami Y., Hirokawa N., Meguro M., Tsuchihashi K., Miura T., et al. Delayed visceral bleeding from liver injury after cardiopulmonary resuscitation. J. Emerg. Med. 2012;43:e245–e248. doi: 10.1016/j.jemermed.2010.05.074. PubMed DOI

de Rooij P.P., Wiendels D.R., Snellen J.P. Fatal complication secondary to mechanical chest compression device. Resuscitation. 2009;80:1214–1215. doi: 10.1016/j.resuscitation.2009.06.011. PubMed DOI

Zahn G., Hauck M., Pearson D.A., Green J.M., Heffner A.C. Major hemorrhage from hepatic laceration after cardiopulmonary resuscitation. Am. J. Emerg. Med. 2015;33:991.e3–991.e4. doi: 10.1016/j.ajem.2014.12.048. PubMed DOI

Næss P.A., Engeseth K., Grøtta O., Andersen G.Ø., Gaarder C. Minimal invasive treatment of life-threatening bleeding caused by cardiopulmonary resuscitation-associated liver injury: A case report. J. Med. Case Rep. 2016;10:132. doi: 10.1186/s13256-016-0926-3. PubMed DOI PMC

Joseph J.R., Freundlich R.E., Abir M. Ruptured subcapsular liver haematoma following mechanically-assisted cardiopulmonary resuscitation. BMJ Case Rep. 2016;2016:bcr2015213951. doi: 10.1136/bcr-2015-213951. PubMed DOI PMC

Monsuez J.J., Charniot J.C., Veilhan L.A., Mougué F., Bellin M.F., Boissonnas A. Subcapsular liver haematoma after cardiopulmonary resuscitation by untrained personnel. Resuscitation. 2007;73:314–317. doi: 10.1016/j.resuscitation.2006.08.017. PubMed DOI

Lardi C., Egger C., Larribau R., Niquille M., Mangin P., Fracasso T. Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS2): A forensic autopsy study. Int. J. Legal Med. 2015;129:1035–1042. doi: 10.1007/s00414-015-1146-x. PubMed DOI

Barbier L., Calmels M., Lagadec M., Gauss T., Abback P.S., Cauchy F., Ronot M., Soubrane O., Paugam-Burtz C. Can we refine the management of blunt liver trauma? J. Visc. Surg. 2019;156:23–29. doi: 10.1016/j.jviscsurg.2018.03.013. PubMed DOI

Doklestić K., Stefanović B., Gregorić P., Ivančević N., Lončar Z., Jovanović B., Bumbaširević V., Jeremić V., Vujadinović S.T., Stefanović B., et al. Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair-single centre experience. World J. Emerg. Surg. 2015;10:34. doi: 10.1186/s13017-015-0031-8. PubMed DOI PMC

Slotta J.E., Justinger C., Kollmar O., Kollmar C., Schäfer T., Schilling M.K. Liver injury following blunt abdominal trauma: A new mechanism-driven classification. Surg. Today. 2014;44:241–246. doi: 10.1007/s00595-013-0515-7. PubMed DOI PMC

Buschmann C.T., Tsokos M. Frequent and rare complications of resuscitation attempts. Intensive Care Med. 2009;35:397–404. doi: 10.1007/s00134-008-1255-9. PubMed DOI

Froment P., Savioz D., Robertson M., Morel P. Lésions hépatiques après massage cardiaque externe efficace--une complication iatrogène à ne pas négliger [Hepatic lesions after effective external cardiac massage—An iatrogenic complication not to be overlooked] Swiss Surg. 1998;5:225–227. PubMed

Cox T.R., Crimmins S.D., Shannon A.M., Atkins K.L., Tesoriero R., Malinow A.M. Liver lacerations as a complication of CPR during pregnancy. Resuscitation. 2018;122:121–125. doi: 10.1016/j.resuscitation.2017.10.027. PubMed DOI

Ondruschka B., Baier C., Bayer R., Hammer N., Dreßler J., Bernhard M. Chest compression-associated injuries in cardiac arrest patients treated with manual chest compressions versus automated chest compression devices (LUCAS II)—A forensic autopsy-based comparison. Forensic Sci. Med. Pathol. 2018;14:515–525. doi: 10.1007/s12024-018-0024-5. PubMed DOI

Smekal D., Johansson J., Huzevka T., Rubertsson S. No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS device—A pilot study. Resuscitation. 2009;80:1104–1107. doi: 10.1016/j.resuscitation.2009.06.010. PubMed DOI

Hoke R.S., Chamberlain D. Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation. 2004;63:327–338. doi: 10.1016/j.resuscitation.2004.05.019. PubMed DOI

Olds K., Byard R.W., Langlois N.E. Injuries associated with resuscitation—An overview. J. Forensic Leg. Med. 2015;33:39–43. doi: 10.1016/j.jflm.2015.04.003. PubMed DOI

Ram P., Menezes R.G., Sirinvaravong N., Luis S.A., Hussain S.A., Madadin M., Lasrado S., Eiger G. Breaking your heart-A review on CPR-related injuries. Am. J. Emerg. Med. 2018;36:838–842. doi: 10.1016/j.ajem.2017.12.063. PubMed DOI

de Graaf C., Donders D.N.V., Beesems S.G., Henriques J.P.S., Koster R.W. Time to Return of Spontaneous Circulation and Survival: When to Transport in out-of-Hospital Cardiac Arrest? Prehosp Emerg. Care. 2021;25:171–181. doi: 10.1080/10903127.2020.1752868. PubMed DOI

Mørk S.R., Bøtker M.T., Christensen S., Tang M., Terkelsen C.J. Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support. Resusc. Plus. 2022;10:100230. doi: 10.1016/j.resplu.2022.100230. PubMed DOI PMC

Chai J., Fordyce C.B., Guan M., Humphries K., Hutton J., Christenson J., Grunau B. The association of duration of resuscitation and long-term survival and functional outcomes after out-of-hospital cardiac arrest. Resuscitation. 2023;182:109654. doi: 10.1016/j.resuscitation.2022.11.020. PubMed DOI