Traumatic liver injury caused by cardiopulmonary resuscitation using an automated sternal compression device that was successfully treated by direct surgical ligation

A 69-year-old man presented to a neighborhood hospital complaining of malaise, and while being examined, developed cardiopulmonary arrest. Cardiopulmonary resuscitation was then carried out using an automated sternal compression device. Thereafter, he was rushed to our hospital, where emergency coronary arteriography was performed after a clinical diagnosis of acute myocardial infarction was made. Coronary revascularization was accomplished by thrombus aspiration, stent placement, and anticoagulant therapy. While the clinical course was uneventful in the initial period after admission to the intensive care unit (ICU), the patient developed circulatory shock of sudden onset at 6 hours after ICU admission. Diagnostic abdominal US and contrast-enhanced CT were performed, which revealed liver injury associated with intraperitoneal hemorrhage caused by sternal compression, therefore, emergency direct surgical ligation was undertaken. Despite a transient worsening of the respiratory condition immediately after the surgery, the patient showed uneventful clinical progress after transfer from the ICU, and he was discharged on foot on postoperative day 28. Hepatic injury caused by cardiopulmonary resuscitation using an automated sternal compression device is extremely rare. The present case underscores the need in medical practice to bear in mind the possibility of serious hepatic injury following cardiopulmonary resuscitation in patients whose hemodynamic state remains unstable despite adequate treatment of the primary disease after resuscitation.