Pectus excavatum and mechanical chest compression of a dangerous bond

Pectus excavatum (PE) is a malformation of the chest characterized by a median depression of the sternum. The incidence of PE is between 0.1% and 0.8%. In the last decade mechanical chest compression devices (MCCD) became of particular interest in cardiopulmonary resuscitation. Different devices became available and this resulted in an increase in their use during CPR mainly for practical reasons. Despite their increasing use, little evidence existed for their effectiveness and little was known about complications. Skin lesions and fractures of sternum or ribs are the ones with the highest incidence. Whereas subdiaphragmatic lesions, in particular fatal liver injuries are uncommon and described only in few case reports. In a recent retrospective study, CT was used to determine the proper compression landmark and depth of cardiopulmonary resuscitation in PE patients. The authors showed that the mean Haller Index in PE patients was higher than in controls, thus exposing internal organs to a higher injury risk during standard CPR maneuvers. We report the first case, to our knowledge, of liver injury during mechanical CPR in a patient with PE. Awareness is being raised on tailoring mechanical CPR in patients with chest deformities. Further exploration is needed to determine if there is a strong correlation between mechanical CPR and organ damage in PE. We believe that this case highlights the importance of individualizing CPR techniques.