Internal Mammary Artery Injury without Chest Wall Fractures after Cardiopulmonary Resuscitation: A Case Report.

Case Reports in Emergency Medicine Pub Date : 2018-10-23 eCollection Date: 2018-01-01 DOI:10.1155/2018/1948151
Sayuri Tokioka, Shinichiro Masuda, Masamitsu Shirokawa, Takashi Shibui
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引用次数: 1

Abstract

High-quality cardiopulmonary resuscitation (CPR) is crucial for survival from cardiac arrest. However, various chest compression-associated injuries have been reported. Internal mammary artery (IMA) injury is one of the rare complications after CPR, and most of cases include rib and sternum fractures. In this report, we describe a rare case of IMA injury without chest wall fractures after CPR. An 85-year-old man with a history of acute myocardial infarction 2 weeks prior visited to our hospital for sustained ventricular tachycardia (VT). After admission, sustained VT requiring CPR occurred several times. Emergency coronary angiogram revealed 90% stenosis at the left anterior descending artery. Hence, emergency percutaneous coronary intervention (PCI) was performed. During the PCI, blood gas analysis showed decreasing serum hemoglobin levels. Contrast computed tomography revealed hemothorax and extravasation at the branch of the right IMA without chest wall fractures. The patient's deteriorating hemodynamic condition precluded thoracotomy or embolization to stop the bleeding. The patient died on the next day of hospitalization. IMA injury can occur after CPR, regardless of chest wall fractures and can be fatal without early diagnosis. For an emergency physician, IMA injury should be considered as a cause of unknown anemia after CPR.

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心肺复苏后无胸壁骨折的乳腺内动脉损伤1例。
高质量的心肺复苏(CPR)对心脏骤停后的生存至关重要。然而,已有各种胸压相关损伤的报道。乳房内动脉损伤是心肺复苏术后罕见的并发症之一,多数病例包括肋骨和胸骨骨折。在此报告中,我们描述了一例罕见的心肺复苏术后IMA损伤无胸壁骨折的病例。一名85岁男性,2周前有急性心肌梗死病史,因持续性室性心动过速(VT)来我院就诊。入院后,持续VT需要心肺复苏术发生多次。急诊冠状动脉造影显示左侧前降支90%狭窄。因此,急诊经皮冠状动脉介入治疗(PCI)。PCI期间,血气分析显示血清血红蛋白水平下降。对比计算机断层扫描显示右IMA分支有胸血和外渗,无胸壁骨折。由于患者血流动力学状况恶化,无法开胸或栓塞止血。病人在住院的第二天死亡。无论胸壁是否骨折,心脏复苏术后都可能发生IMA损伤,如果不进行早期诊断,IMA损伤可能致命。急诊医师应将IMA损伤视为心肺复苏术后不明原因贫血的原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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审稿时长
12 weeks
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