Traumatic Liver Injury With Delayed Bleeding After Extracorporeal Cardiopulmonary Resuscitation

Although chest compressions are a crucial component of cardiopulmonary resuscitation (CPR), they can sometimes result in traumatic complications. The incidence of hepatic injury, although rare relative to rib and sternal fractures, may result in severe hemorrhage and may be fatal, especially in patients receiving concomitant antiplatelet and anticoagulant therapy. This risk is particularly pronounced after extracorporeal CPR (E-CPR), as dual antiplatelet therapy (DAPT) for acute coronary syndrome and unfractionated heparin for preventing circuit thrombosis are required. We present a case of traumatic liver injury (TILI) following E-CPR for refractory ventricular fibrillation (VF) owing to acute myocardial infarction (AMI). In the absence of contrast extravasation on contrast-enhanced computed tomography (CT), nonoperative management was initially selected. However, the patient became transfusion-dependent despite receiving conservative management, prompting transcatheter arterial embolization (TAE), which resulted in rapid hemodynamic stabilization. The patient survived with a favorable neurological outcome. The present case highlights the need for maintaining a high index of suspicion for occult bleeding after E-CPR and underpins early minimally invasive hemostatic interventions, even in the absence of radiographic extravasation.