ReviewGastric perforation after cardiopulmonary resuscitation: Review of the literature☆
Section snippets
Methods
We searched Medline/PubMed for all cases of gastric perforation after resuscitation up to 15 August 2009 using the keywords (perforation OR rupture OR pneumoperitoneum OR laceration) AND (gastric OR stomach) AND (resuscitation OR BLS OR ALS OR CPR OR cardiac arrest). The references of the retrieved publications were also searched for additional cases. The full text version of all cases was carefully analysed. Reports were only included if they included sufficient information regarding the
Results
Sixty-seven reported cases of gastric perforation after CPR, in adults and in children, were identified (Table 1).2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 The ages ranged from 5 months up to 87 years. The male-to-female ratio was similar (35:32). Data on chest compressions were provided for 56 patients, and mouth-to-mouth resuscitation alone was
Discussion
The most common causes of pneumoperitoneum include a perforated appendix, duodenal and gastric ulcer, colon diverticulum and perforation of the bowel secondary to inflammatory bowel disease.50 Less frequent causes include positive pressure ventilation with pneumothorax, orogenital insufflation and aerophagia. Mortality rates may be high due to peritonitis and septic shock.38
Following CPR gastric mucosal tears occurred in 9–12% of patients.26, 30, 40
On the one hand, gastric distension secondary
Conclusion
Cardiopulmonary resuscitation can cause gastric perforation. It should be considered in cardiac arrest survivors when there is abdominal distension and air under the diaphragm on a semi-erect chest radiograph. Surgical treatment should be considered for gastric perforation.
Conflict of interest
All authors disclose no financial and personal relationships.
Acknowledgements
The secretarial assistance of Hilde Fleurackers and Kim De Rycke is greatly acknowledged.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.11.023.