| Abstract: Aims
The purpose of this case report is to highlight the potential role of emergency surgical decompression of the abdomen during a cardiac arrest in the setting of acute abdominal compartment syndrome.
Methods and Results - Case Report
A 56 year old man was transferred from a country hospital with suspected pulmonary embolism and was commenced on low molecular weight heparin. On the third day in hospital he developed acute abdominal pain. A CT scan of the abdomen showed a retroperitoneal haemorrhage. He developed features of abdominal compartment syndrome and during resuscitation in the intensive care unit he suffered a cardiac arrest. He had electromechanical dissociation followed by pulseless ventricular tachycardia. Neither were reversed by cardiopulmonary resuscitation, adrenaline, defibrillation and volume loading. An emergency lower midline minilaparotomy was performed in ICU and 800ml of blood was suctioned out. He spontaneously reverted to a sinus rhythm and had a blood pressure of 93/48 immediately following decompression. He was then transferred to the operating theatre where a laparostomy was performed. He improved and went on to have an omentoplasty and mesh repair of his ventral hernia which was closed with a vacuum sponge dressing. Skin grafting was performed several weeks later and was discharged from hospital after a 2 month stay. He continues to be well on review in the surgical outpatient clinic.
Discussion
This case is a rare scenario where emergency abdominal decompression during a cardiac arrest in the setting of abdominal compartment syndrome has successfully restored cardiac output. This information could be included in the Australian Resuscitation Council guidelines.
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