Cardiac perforation and tamponade induced by external cardiac massage: a case report

A 76-year-old woman suffered from sudden loss of consciousness while sitting in a chair. She was sent to a local hospital and found to be in shock. After a brief period of external cardiac massage, she was transferred to our hospital. In our emergency department she was lethargic with cool, clammy extremities. Her blood pressure dropped from 113/53 mmHg on arrival to 72/42 mmHg 2 hours later. Echocardiography showed massive pericardial effusion, fair left ventricular contractility and no abnormal segmental motion. The echocardiographic appearance suggested fibrin-like substance in the pericardial space, which was felt to indicate the presence of blood. Enhanced chest computerized tomography showed extravasation of contrast medium from the right ventricular outflow tract. At surgery, a small perforation was found at the infundibular area of the right ventricle, and a total of 500 mL of blood had accumulated in the pericardial space. She was discharged 7 days postoperatively, having made an uneventful recovery. External cardiac massage may cause cardiac disruption, and this should be considered in patients who have secondary hemodynamic instability following successful cardiopulmonary resuscitation.