Although life-saving, cardiopulmonary resuscitation (CPR) has been associated with traumatic injuries in adult patients surviving cardiac arrest. In addition to rib and sternal fractures, intraabdominal injuries have also been shown to occur, particularly after prolonged external cardiac massage. Early detection of these injuries remains difficult and is often masked by concomitant hemodynamic instability and the higher likelihood of other injuries such as retroperitoneal hemorrhage. Accurate diagnosis is further complicated when venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is instituted. As such, it is imperative for ECMO providers to maintain a high index of suspicion for intraabdominal/intraperitoneal solid organ injury and hemoperitoneum when managing patients who survive prolonged cardiac arrest. Furthermore, fluctuating or low ECMO circuit flow rates despite volume infusion may serve as indicators of intraabdominal bleeding and should be promptly assessed.
From the *Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
†The Ohio State University College of Medicine
‡Perfusion Services, Duke University Medical Center, Durham, North Carolina.
Submitted for consideration September 2018; accepted for publication in revised form October 2018.
Disclosure: The authors have no conflicts of interest to report.
Correspondence: David Ranney, Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center 3867, Durham, NC 27710. E-mail: firstname.lastname@example.org.