Sir,
With great interest, we read Cox et al.’s article, which focused on three cases of liver lacerations in women suffering from cardiac arrest (CA) during peripartum [
[1]
]. The authors hypothesized that, due to disseminated intravascular coagulation, pregnant women are predisposed to liver injuries induced by chest compressions. The need to diagnose liver injuries must be taken into account in cases involving hemodynamically unstable patients after cardiopulmonary resuscitation (CPR).We report a short retrospective case series drawn from our experience in Paris and its suburban areas. For the delivery of highest-quality CPR, our BLS teams currently use ACD-CPR (active compression-decompression), while our ALS teams use an automated chest-compression device. From 2009–2014, we found 17 cases of pregnant women suffering from out-of-hospital CA (IRB 00010254-2016-149). Four of these 17 women were in a peripartum period. These 4 patients’ epidemiological and clinical features are described in Table 1.
Table 1Four women who experienced mechanical chest compression after prehospital peripartum cardiac arrest.
| Patient | Gestational age (weeks) | Parity | Etiology related to cardiac arrest | Length of now-flow (minutes) | Length of low-flow (minutes) | ROSC | Liver injury | Complications post-resuscitation | Transfusion | Status |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 37 | 2 | Hypertrophic cardiomyopathy | 20 | >60 | No | No | DIC | 8 RBC, | Died 9 h after CPR |
| 6 FFP, and | ||||||||||
| 5 g Fibrinogen | ||||||||||
| 2 | 39 | 1 | Remains unknown | 10 | >60 | No | No | DIC | No | Died 16 h after CPR |
| 3 | 34 | 1 | Massive pulmonary embolism | 0 | >60 | No | No | No available | No | Died 40 min after CPR |
| 4 | 31 | 2 | Acute myocardial infarction | 20 | >60 | Yes | No | No | No | Died 2 h after CPR |
ROSC, return of spontaneous circulation; CPR, cardiopulmonary resuscitation; DIC, disseminated intravascular coagulation; RBC, red blood cells; FFP, fresh frozen plasma; g, gram.
Certainly, we cannot claim on the basis of only 4 cases that ACD-CPR is less likely than standard manual CPR to cause liver lacerations in peripartum patients. However, our practice with ACD-CPR does lead us to ask the authors whether an ACD could be used, by taking precautionary measures to apply it slightly higher on the sternum than in manual CPR, to ensure that the ACD-CPR’s suction cup stays above the fundus uteri and, therefore, is less likely to harm pregnant women’s livers. Furthermore, we talk about the safety of an automated chest compression device for use with pregnant women because of its regular intervals of chest compressions and its constant applied pressure.
Finally, to assess the real effect that chest compressions may have on the liver, it may be necessary to report both the hands’ position during closed chest compressions and the method that was used—active compression decompression (CardioPump®), automated chest-compression device, or manual chest compression—as Utstein elements in a patient’s record after CPR is performed [
2
, 3
, 4
].- Perkins G.D.
- Jacobs I.G.
- Nadkarni V.M.
- Berg R.A.
- Bhanji F.
- Biarent D.
- et al.
Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.
Resuscitation. 2015; 96: 328-340
Conflicts of interest
None of the author of this manuscript have any conflicts of interest.
Funding source
None.
References
- Liver lacerations as a complication of CPR during pregnancy.Resuscitation. 2018; 122: 121-125
- Cardiac arrest and resuscitation with an automatic mechanical chest compression device (LUCAS) due to anaphylaxis of a woman receiving caesarean section because of pre-eclampsia.Resuscitation. 2006; 68: 155-159
- Safety of mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority.Eur Heart J. 2017; 38: 3006-3013
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.Resuscitation. 2015; 96: 328-340
Article info
Publication history
Published online: January 02, 2018
Received:
November 12,
2017
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© 2018 Elsevier B.V. All rights reserved.
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- Liver lacerations as a complication of CPR during pregnancyResuscitationVol. 122
- PreviewCardiac arrest in peripartum patients is a rare but devastating event; reported rates in the literature range from 0.019% to 0.0085%. In the general population, a well-described complication of cardiopulmonary resuscitation (CPR), liver laceration and injury, is reported at a rate of between 0.5–2.9% after CPR. Liver laceration rate among peripartum patients receiving CPR has not been well-studied. We sought to find the rate of liver lacerations in the peripartum population associated with CPR, with the hypothesis that the rate would be higher than in the general population.
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