Obstructive shock with mediastinal hematoma caused by chest compressions after successful primary percutaneous...

Area of Science:

• Cardiology
• Interventional Cardiology
• Trauma Surgery

Background:

• ST-segment elevation myocardial infarction (STEMI) can lead to cardiac arrest.
• Primary percutaneous coronary intervention (PCI) is crucial after successful cardiopulmonary resuscitation (CPR).
• High-dose antiplatelet therapy increases bleeding risk post-PCI.

Observation:

• A 75-year-old male presented with pulseless ventricular tachycardia secondary to STEMI.
• Following successful primary PCI, the patient developed obstructive shock due to massive mediastinal hematoma.
• The hematoma was suspected to be a complication of chest compressions during CPR, exacerbated by high-dose antiplatelet therapy.

Findings:

• Echocardiography and CT scan confirmed a large mediastinal hematoma.
• Emergency surgical evacuation of the hematoma and hemostasis were successfully performed.
• The patient's condition stabilized after surgical intervention.

Implications:

• CPR-induced trauma can lead to severe hemorrhage, particularly in patients on antiplatelet agents.
• Close hemodynamic monitoring is essential after PCI for STEMI, even after successful revascularization.
• Massive mediastinal hematoma is a rare but critical complication requiring prompt surgical management.