Author/Editor		Željko, Tadej; Sinkovič, Andreja
Title		Intraabdominal bleeding after cardiopulmonary resuscitation due to pulmonary embolism - A case report
Type		članek
Source		Slov Kardiol
Vol. and No.		Letnik 5, št. 1
Publication year		2008
Volume		str. 68-72
Language		eng
Abstract		Ventricular fibrillation is (VF) is the most important cause of cardiac arrests, which mainly occurs due to coronary heart disease and rarely due to pulmonary embolism (PE). After successful cardiopulmonary resuscitation (CPR), further interventions are directed towards the prevention and diagnosis of the underlying disease to be able to start appropriate causative therapy. In PE, heparin therapy is mandatory to prevent recurences, but it canlead to bleeding complications. This article presents the case of a 68-yearold man afteer prolonged, but succesful CPR due to VF, who was comatose on admission and mechanically ventilated. After acute myocardial infarction was excluded, massive PE was suspected due to right ventricular pressure overload as demonstrated by echocardiography and increased D-dimers. PE was confirmed by thoracic CT using contrast. Heparin treatment was started, and the patient regained consciousness after 48 hours was extubated. The next day, severe anemia developed as a result of intraabdominal bleeding as demonstrated by abdominal ultrasound and puncture. Surgical laparotomy confirmed intraabdominal and retroperitoneal hemorrhage, ruptured spleen and subcapsular hepatic hemorrhage. After surgery, the patient recovered completly. On discharge, he was without neurological sequelae but received anticoagulation treatment. It is therefore concluded that severe bleeding after CPR is possible in particular with concomitant use of antithrombotic therapy, which is necessary after massive PE.
Summary		Prekatna fibrilacija (VF) je najpomembnejši vzrok srčnega zastoja zaradi koronarne bolezni srca in le redko zaradi pljučne embolije (PE). Po uspešnem oživljanju so nadaljnji ukrepi preprečevanje ponovitve in postavitev diagnoze osnovne bolezni, da se lahko prične ustrezno vzročno zdravljenje. Pri PE je nujno zdravljenje s heparinom, ker preprečuje ponovitve, vendar lahko vodi do krvavitev. Predstavljamo 68-letnega moškega po dolgem in uspešnem oživljanju zaradi PF, ki je ob sprejemu nezavesten in mehanično predihan. Po izključitvi akutnega infarkta srca, je bil postavljen sum na masivno PE zaradi tlačne obremenitve desnega prekata, dokazane z ehokardiografijo in zaradi povišanih vrednosti D-Dimer. PE je bila potrjena s CT prsnega koša s kontrastom. Takoj smo pričeli zdraviti s heparinom. Bolnik se je po 48 urah ovedel. Naslednji dan se je pojavila težka slabokrvnost, ki je bila posledica krvavitev v trebušno votlino, kar je pokazal ultrazvični pregled trebuha z abdominalno punkcijo. Kirurška laparotomija je potrdila krvavitev v trebuh in retroperitonealno, rupturo vranice in krvavitev iz jeter. Po uspešnem operativnem posegu je bolnik popolnoma okreval. Ob odpustu je bil brez nevroloških posledic, vendar je prejemal antikoagulantno zdravljenje. Naši zaključki so, da je težka krvavitev možni zaplet po oživljanju posebno pri uporabi antitrombotičnega zdravljenja, kot je to potrebno pri masivni PE.
Descriptors		CARDIOPULMONARY RESUSCITATION HEART ARREST VENTRICULAR FIBRILLATION PULMONARY EMBOLISM GASTROINTESTINAL HEMORRHAGE