[Specific risks of active compression-decompression in cardiopulmonary resuscitation: a case report]

Circulatory effects of cardiopulmonary resuscitation with active compression-decompression (CPR-ACD) are superior to the conventional technique. Decompression, thoracic expansion and a corresponding suction effect obviously improves cardiac preload. Due to significant or unphysiological thoracic expansion, thorax, diaphragma, and epigastrium are exposed to considerable traction powers. In a patient with fulminant pulmonary embolism, conventional cardiac massage and ACD were maintained during 65 minutes with simultaneous systemic thrombolytic therapy. After CPR, the patient developed a massive haemorrhagic shock. During emergency laparotomy, significant adhesions of upper abdominal organs with serious injuries of spleen and liver were found. Traction powers during CPR-ACD in combination with abdominal adhesions are considered responsible. Until improved outcome of CPR-ACD is demonstrated in larger clinical investigations, at least initially conventional cardiac massage should be preferred before the ACD-technique is used. Special attention to patients with a history of upper abdominal operations or chronic inflammatory lung diseases is mandatory.