Gastric perforation following improper cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Guang-Ju Zhou,Shou-Yin Jiang,Pin Jin

doi:10.12669/pjms.36.2.1363

Guang-Ju Zhou, Shou-Yin Jiang + Show 1 more

Open Access

https://doi.org/10.12669/pjms.36.2.1363

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Abstract

Gastric perforation is a rare complication of cardiopulmonary resuscitation (CPR), mostly resulting from incorrect airway management. If left unrecognized, it is associated with high mortality and morbidity. We present a case of gastric perforation after improper CPR. A 56-year-old drunken male was sent to the emergency department due to coma after fall onto the ground. He was thought to have cardiac arrest at scene and was saved with CPR maneuver by his friends who has never been trained before. He was taken to the hospital by emergency medical service personnel and presented with abdominal distention and extensive pneumoperitoneum. Emergency laparotomy was performed which revealed gastric perforation at the lesser curvature of the stomach. The laceration was repaired without any difficulty and the patient was discharged home without any neurological deficit. The aim of this report is to remind the public and emergency physicians that gastric perforation should be suspected in patients with distended abdomen and pneumoperitoneum after CPR. Because the most common risk factor for CPR-related gastric perforation is the bystander-provided resuscitation, it is encouraged for the public to take formal CPR training.

Highlights

Cardiac arrest is a life-threatening medical condition affecting millions of individuals1
October 25, 2019 annually, which has been associated with poor survival and/or neurological outcome partly due to lack of public knowledge of cardiopulmonary resuscitation (CPR)
Abdominal distension not relieved by gastric decompression or a hemorrhagic gastric aspiration may be indicative of perforation, and emergency laparotomy should be considered

Summary

INTRODUCTION

Cardiac arrest is a life-threatening medical condition affecting millions of individuals. A 56-year-old male presenting with coma was brought to the emergency room in the morning Forty minutes earlier, he suddenly fell onto the ground when drinking with his friends who found him to be unresponsive later. He suddenly fell onto the ground when drinking with his friends who found him to be unresponsive later It was uncertain if he had spontaneous breathing and circulation at that time. The emergency medical service personnel arrived, they assessed that the patient was unresponsive, with shallow breath and a pulse of 122 beats/min. He was immediately intubated and transported to the local hospital. Chest and abdomen CT scan revealed extensive pneumoperitoneum (Fig.[1]). He was discharged home nine days later without any neurological deficits

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