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Cardiopulmonary resuscitation-associated major liver injury.

机译：心肺复苏相关的重大肝损伤。

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摘要

AIM: To evaluate the frequency, presentation, treatment and outcome of cardiopulmonary resuscitation-associated major liver injury in patients after non-traumatic in- or out-of-hospital cardiac arrest. MATERIALS AND METHODS: Retrospective analysis of a cardiac arrest registry in a tertiary care hospital emergency department. We reviewed patients charts, laboratory data, diagnostic imaging studies and autoptic findings. RESULTS: Within 14.5 years, major liver injury (rupture/laceration, haemorrhage/haematoma) was found in 15 of 2558 cardiac arrest victims (0.6%). Eleven were male (73%), median age was 58 (IQR 53-67). In seven, resuscitation was started out-of-hospital. In 9 of the 15 patients, liver injury was correctly diagnosed intra vitam. In 5, haematocrit level was low on admission, in 8 haematocrit dropped significantly during observation; haemostasis was compromised in 13 patients, 4 of them receiving thrombolytic therapy. Bedside abdominal sonography showed free intra-peritoneal fluid in 8 of 9 cases examined. In 11 patients, we found liver rupture/laceration, in 4 liver haemorrhage/haematoma. The site of injury was the left liver lobe in 11, six underwent emergent surgery. Two of 15 patients survived to 6 months in good neurological condition, 1 after emergency surgery. No patient died from bleeding due to liver injury. CONCLUSION: Our single centre observation confirms that resuscitation-associated major liver injury is infrequent and shows that most patients had compromised haemostasis. Low or dropping haematocrit should trigger suspicion. Bedside sonography reveals intra-peritoneal fluid or liver injury. A conservative therapeutic approach or emergency surgery may be warranted. Major liver injury alone scarcely appears to influence overall outcome.
机译：目的：评估非创伤性院内或院外心脏骤停后患者心肺复苏相关的重大肝损伤的发生频率，表现，治疗和结果。材料与方法：对三级医院急诊科的心脏骤停登记进行回顾性分析。我们审查了患者图表，实验室数据，诊断性影像学研究和尸检结果。结果：在14.5年内，在2558名心脏骤停患者中有15名发现了严重的肝损伤（破裂/裂伤，出血/血肿）（0.6％）。男性为11名（73％），中位年龄为58岁（IQR 53-67）。七名患者在院外开始复苏。 15例患者中有9例在玻璃体内正确诊断出肝损伤。入院时有5例血细胞比容水平低，观察期间有8例血细胞比容显着下降; 13例患者止血受损，其中4例接受溶栓治疗。在检查的9例病例中有8例在床旁腹部超声检查显示有腹膜内游离液。在11例患者中，我们发现4例肝出血/血肿中有肝破裂/裂伤。受伤的部位是11例中的左肝叶，其中6例接受了紧急手术。 15例患者中有2例在紧急手术后1例神经功能良好，存活至6个月。没有患者因肝损伤而死于出血。结论：我们的单中心观察证实了与复苏相关的严重肝损伤并不常见，并且表明大多数患者的止血功能受损。血细胞比容低或下降应引起怀疑。床旁超声检查显示腹膜内积液或肝损伤。可能需要采取保守的治疗方法或紧急手术。仅严重的肝损伤似乎几乎不会影响总体预后。

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