Elsevier

Resuscitation

Volume 81, Issue 3, March 2010, Pages 272-280
Resuscitation

Review
Gastric perforation after cardiopulmonary resuscitation: Review of the literature

https://doi.org/10.1016/j.resuscitation.2009.11.023Get rights and content

Abstract

The risk of complications of cardiopulmonary resuscitation (CPR) does not outweigh the benefit of a successful restoration of a spontaneous circulation. Despite the frequent occurrence of gastric distension (caused by air entering the stomach because of too forceful and/or too quick rescue breathing), there are few reports of massive gastric distension causing gastric rupture and pneumoperitoneum after CPR. We reviewed all 67 case reports of gastric perforation that have been reported after CPR. Although uncommon, this review stresses the need to consider this potentially lethal complication after initial successful resuscitation.

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.

References (53)

  • C.M. Bush et al.

    Pediatric injuries from cardiopulmonary resuscitation

    Ann Emerg Med

    (1996)
  • N.J. Demos et al.

    Gastric rupture occurring during external cardiac resuscitation

    Surgery

    (1964)
  • E.J. Valtonen et al.

    Rupture of the normal stomach during mouth-to-mouth resuscitation

    Acta Chir Scand

    (1964)
  • R. Courbier et al.

    Cardiac arrest and gastric perforation

    Agressologie

    (1966)
  • P.P. Anthony et al.

    Gastric mucosal lacerations after cardiac resuscitation

    Br Heart J

    (1969)
  • W.H. Cassebaum et al.

    Rupture of the stomach from mouth-to-mouth resuscitation

    J Trauma

    (1974)
  • M. Solowiejczyk et al.

    Rupture of the stomach following mouth-to-mouth respiration

    Postgrad Med J

    (1974)
  • S.G. Darke et al.

    Case of complete gastric rupture complicating resuscitation

    Br Med J

    (1975)
  • G. Ducable et al.

    Gastric ruptures after resuscitation

    Anesth Analg (Paris)

    (1978)
  • M. Matikainen

    Rupture of the stomach: a rare complication of resuscitation

    Acta Chir Scand

    (1978)
  • L. Gisselsson et al.

    Rupture of the stomach after heart–lung resuscitation

    Lakartidningen

    (1979)
  • R.D. Evans et al.

    Gastric rupture as a complication of cardiopulmonary resuscitation: report of case and review of literature

    J Am Osteopath Assoc

    (1981)
  • E. Shemesh et al.

    Rupture of stomach due to external cardiac resuscitation

    Isr J Med Sci

    (1983)
  • D. Engelstein et al.

    Gastric rupture complicating mouth-to-mouth resuscitation

    Isr J Med Sci

    (1984)
  • A. Gainant et al.

    Pneumoperitoneum following cardiorespiratory resuscitation procedures

    Presse Méd

    (1984)
  • S. Krause et al.

    Gastric rupture during cardiopulmonary resuscitation

    Can Anaesth Soc J

    (1984)
  • Cited by (51)

    • Pneumoperitoneum following cardiopulmonary resuscitation: An unusual case

      2022, International Journal of Surgery Case Reports
      Citation Excerpt :

      Furthermore, it is widely acknowledged that the quality of CPR delivered during resuscitation attempts falls short of standard guidelines due to a lack of formal training, which can be harmful. Complications from CPR can include rib fractures, haemothorax, pneumothorax, hepatosplenic injuries, and cardiac contusion or laceration [3,4]. Pneumoperitoneum can occasionally result from chest compressions and positive pressure ventilation, which cause esophageal tears and tracheobronchial disruption, allowing air to move from the thoracic cavity to the peritoneal cavity [5].

    • Complete gastroesophageal junction avulsion after near drowning: A case report and review of literature

      2020, International Journal of Surgery Case Reports
      Citation Excerpt :

      Similarly, during CPR, the forces applied during external compressions, the additional introduction of air via resuscitative ventilation and esophageal intubation increases the risk of perforation. While CPR related gastric perforations are well described in the literature [10], gastric perforations secondary to drowning are rare, with only one case reported previously [11]. Even rarer are injuries of the GE junction.

    View all citing articles on Scopus

    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.

    View full text