Castro GCA, Belalcazar GM, Rosas ÁF, Álvarez MR

Language: Spanish
References: 20
Page: 336-340
PDF size: 1440.66 Kb.

ABSTRACT

Aortic injuries associated with chest compressions during cardiopulmonary resuscitation (CPR) are uncommon but potentially fatal. The spectrum of injury includes intimal tears, intramural hematoma, aortic dissection, and complete rupture. Most published cases correspond to autopsy findings or isolated reports diagnosed by echocardiography or computed tomography. We report the case of a 54-year-old woman admitted after an out-of-hospital cardiac arrest. During the initial emergency department evaluation, point-of-care ultrasound (POCUS) revealed a large pericardial effusion with echocardiographic signs of hemodynamic compromise. Computed tomography angiography demonstrated bilateral pulmonary embolism, multiple rib fractures, and rupture of the ascending aorta with hemopericardium. Emergent cardiovascular surgery confirmed traumatic transection of the ascending aorta associated with extensive intramural hematoma and pre-existing aneurysmal dilation. Ascending aortic replacement with a vascular graft was performed. Despite surgical intervention and intensive care support, the patient developed progressive multiorgan failure and extensive neurological injury, ultimately resulting in death. This case highlights the importance of considering major vascular injuries in patients with hemodynamic instability after CPR, particularly in the presence of underlying aortic disease, and underscores the role of POCUS in the early recognition of potentially fatal post-resuscitation mechanical complications.

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