Vertebral fracture as a complication of cardiopulmonary resuscitation
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IMAGING IN INTENSIVE CARE MEDICINE
Vertebral fracture as a complication of cardiopulmonary resuscitation H. Merdji* , C. Poussardin, J. Helms and F. Meziani © 2018 Springer-Verlag GmbH Germany, part of Springer Nature and ESICM
An intubated 88-year-old woman was admitted to the intensive care unit (ICU) after return of spontaneous circulation following cardiopulmonary resuscitation (CPR) from cardiac arrest. Two hours before, her nurse called the Urgent Medical Aid Service because of an acute respiratory failure. When the rescue team arrived, the patient, who had a known aortic stenosis, had signs of pulmonary edema that rapidly led to a cardiac arrest. She underwent vigorous CPR for approximately 10 min
before spontaneous circulation returned, with a normal EKG. To note, rescuers did active compression-decompression CPR with a hand-held device (CardioPump®) consisting of a suction cup that was attached to the chest. After she woke up without any neurological deficit, a chest computed tomography scan (CT scan) was performed for a pre-transcatheter aortic valve implantation (TAVI) assessment and revealed multiple rib fractures but also a CPR-induced thoracic vertebral fracture (Fig. 1).
Fig. 1 a Sagittal plane of the thoracic CT scan showing an unstable fracture of the T10 vertebral body (white arrow), presumably by hyperextension mechanism with distraction of the T9–T10 intervertebral disc. b Axial plane of the thoracic CT scan showing the acutely fractured tenth thoracic vertebra (white arrow)
*Correspondence: [email protected] Service de Réanimation, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
The patient had no history of osteoporosis, vertebral compaction, or antecedent trauma. A neurosurgeon advised a short-term intervention once the patient’s condition stabilized. Skeletal injuries, especially fractures of rib and sternum, are frequently reported complications of CPR. However, even if thoracic vertebral fractures are rare complications, they can lead to serious damage such as potential spinal cord injury and paraplegia. The incidence may increase with the aging population along with the increased use of CPR devices. Abbreviations CT-scan: Computed tomography scan; ICU: Intensive care unit; TAVI: Transcatheter aortic valve implantation. Author contributions Drafting and revision of the manuscript: HM, CP, JH, FM.
Funding For this work, no funding has been received from any organization and no financial support was necessary, including departmental or institutional funding. Compliance with ethical standards Conflicts of interest The authors declare that there is no conflict of interest regarding the publication of this article. Informed consent The patient gave her consent for this submission. Received: 5 April 2018 Accepted: 7 April 2018
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