CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional Centers
<b>Background:</b> Cardiopulmonary resuscitation (CPR) is performed in cardiac arrests. There exist life support guidelines for individuals in performing effective CPR. CPR-related bleeding and hemothoraces are rare. Intercostal artery rupture leading up to shock and respiratory compromi...
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2024-08-01
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| author | Vaikunthan Thanabalasingam Clement Tan Chaminda Sella Kapu Mark Daniel Higgins Zhihua Zhang |
| author_facet | Vaikunthan Thanabalasingam Clement Tan Chaminda Sella Kapu Mark Daniel Higgins Zhihua Zhang |
| author_sort | Vaikunthan Thanabalasingam |
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| description | <b>Background:</b> Cardiopulmonary resuscitation (CPR) is performed in cardiac arrests. There exist life support guidelines for individuals in performing effective CPR. CPR-related bleeding and hemothoraces are rare. Intercostal artery rupture leading up to shock and respiratory compromise in such situations is rare. Here, we present a unique case with a management dilemma while discussing challenges and guidance to regional centers. <b>Case presentation:</b> A 49-year-old Caucasian male experienced an out-of-hospital cardiac arrest which required bystander cardiopulmonary resuscitation from a colleague prior to commencement of lysis protocol at the local hospital. Transfer was later arranged to the nearest cardiac catheterization laboratory where a rescue percutaneous coronary intervention was performed in the left anterior descending artery that required strict dual antiplatelet use. Beneath the shroud of these events was a life-threatening right-sided hemothorax from rupture of intercostal arteries that occurred during initial resuscitation. Astute recognition of this post-percutaneous coronary intervention resulted in eventual transfer of the patient to a tertiary center where the source and the collection of the bleed was addressed. The patient’s took a great trajectory to improvement. <b>Conclusions:</b> A regional center poses many challenges and limitations. Massive bleeding from intercostal arteries leading to hemorrhagic shock and respiratory compromise from an expanding hemothorax post-CPR is rare. Post-percutaneous coronary intervention use of dual antiplatelets posed a management dilemma that prompted assistance from tertiary counterparts. Clinicians should be astute and quick in assessing and providing care. |
| format | Article |
| id | doaj-art-c46b3f732b7249d4bf34dc5ed76a38d6 |
| institution | OA Journals |
| issn | 2571-841X |
| language | English |
| publishDate | 2024-08-01 |
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| spelling | doaj-art-c46b3f732b7249d4bf34dc5ed76a38d62025-08-20T01:55:49ZengMDPI AGReports2571-841X2024-08-01736910.3390/reports7030069CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional CentersVaikunthan Thanabalasingam0Clement Tan1Chaminda Sella Kapu2Mark Daniel Higgins3Zhihua Zhang4Coronary Care Unit & Cardiac Catheterisation Laboratory, Department of Cardiology, Mackay Base Hospital, Mackay, QLD 4740, AustraliaCoronary Care Unit & Cardiac Catheterisation Laboratory, Department of Cardiology, Mackay Base Hospital, Mackay, QLD 4740, AustraliaCoronary Care Unit & Cardiac Catheterisation Laboratory, Department of Cardiology, Mackay Base Hospital, Mackay, QLD 4740, AustraliaCoronary Care Unit & Cardiac Catheterisation Laboratory, Department of Cardiology, Mackay Base Hospital, Mackay, QLD 4740, AustraliaCoronary Care Unit & Cardiac Catheterisation Laboratory, Department of Cardiology, Mackay Base Hospital, Mackay, QLD 4740, Australia<b>Background:</b> Cardiopulmonary resuscitation (CPR) is performed in cardiac arrests. There exist life support guidelines for individuals in performing effective CPR. CPR-related bleeding and hemothoraces are rare. Intercostal artery rupture leading up to shock and respiratory compromise in such situations is rare. Here, we present a unique case with a management dilemma while discussing challenges and guidance to regional centers. <b>Case presentation:</b> A 49-year-old Caucasian male experienced an out-of-hospital cardiac arrest which required bystander cardiopulmonary resuscitation from a colleague prior to commencement of lysis protocol at the local hospital. Transfer was later arranged to the nearest cardiac catheterization laboratory where a rescue percutaneous coronary intervention was performed in the left anterior descending artery that required strict dual antiplatelet use. Beneath the shroud of these events was a life-threatening right-sided hemothorax from rupture of intercostal arteries that occurred during initial resuscitation. Astute recognition of this post-percutaneous coronary intervention resulted in eventual transfer of the patient to a tertiary center where the source and the collection of the bleed was addressed. The patient’s took a great trajectory to improvement. <b>Conclusions:</b> A regional center poses many challenges and limitations. Massive bleeding from intercostal arteries leading to hemorrhagic shock and respiratory compromise from an expanding hemothorax post-CPR is rare. Post-percutaneous coronary intervention use of dual antiplatelets posed a management dilemma that prompted assistance from tertiary counterparts. Clinicians should be astute and quick in assessing and providing care.https://www.mdpi.com/2571-841X/7/3/69cardiopulmonary resuscitationhemothoraxhemorrhagic shockrespiratory compromiseintercostal arteries |
| spellingShingle | Vaikunthan Thanabalasingam Clement Tan Chaminda Sella Kapu Mark Daniel Higgins Zhihua Zhang CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional Centers Reports cardiopulmonary resuscitation hemothorax hemorrhagic shock respiratory compromise intercostal arteries |
| title | CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional Centers |
| title_full | CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional Centers |
| title_fullStr | CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional Centers |
| title_full_unstemmed | CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional Centers |
| title_short | CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional Centers |
| title_sort | cpr induced life threatening hemothorax in a rescue pci patient case report and brief challenges of regional centers |
| topic | cardiopulmonary resuscitation hemothorax hemorrhagic shock respiratory compromise intercostal arteries |
| url | https://www.mdpi.com/2571-841X/7/3/69 |
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