To our knowledge this is the first description of CPR-induced type-B aortic dissection. The recent American Heart Association CPR guidelines recommend: “to give ‘effective’ chest compressions, ‘push hard and push fast…’”[1]. Such aggressive resuscitation attempts require aggressive manipulation of a patient, and may lead to complications. These resuscitation-related injuries include damage to the chest, airway and abdomen. The most frequent bony injuries seen as a result of CPR in adults are rib (frequency of 13–97%) and sternal (frequency 1–43%) fractures [2]. Fractured ribs can cause pericardial tamponade, injuries of the myocardium, pericardium, pleura, diaphragm and pneumothoraces as well as hemothoraces. In such cases, success of resuscitation efforts is negatively affected [3].
Although visceral structures are affected less than thoracic structures from resuscitation-related trauma, upper abdominal organs such as liver, stomach and spleen might be injured as well [4–6]. These injuries result mainly from fractured ribs or sternum which can lead to visceral perforation and rupture during CPR.
Vascular injuries as a result of CPR are very rare. Klintschar et al. [5] reported a case of an 84-year-old female following 3 min of conventional CPR and 15 min of active compression–decompression device, which resulted in an extensive cardiac injury that included a series of rib fractures, a transverse fracture of the sternum, and rupture of the pericardial sac, the right ventricle, both atria and lacerations of the ascending aorta. In this case, however, the trauma from CPR was not isolated to the aorta and included heart structures as well. Isolated aortic rupture from CPR is rare, and has been described in the literature with a frequency of 1% [7].
Unlike ventricular fibrillation and pulseless ventricular tachycardia where the pattern and rhythm of electrical activity is the focus of treatment rather than the underlying cause, PEA and asystole are corrected by addressing the underlying cause [8]. Ultrasound is a diagnostic tool with increasing applications and use in emergency situations [9]. Echocardiography can help with rapid diagnosis of etiology of PEA arrest and asystole, and guide therapy during these crucial moments. In our case it was critical for the diagnosis of an unknown severe aortic stenosis and helped us guide appropriate therapy. Finally, without echocardiography, the diagnosis of type B aortic dissection would have not been made.