A53-38 Liver Laceration Leading to Abdominal Compartment Syndrome Following Mechanical Cardiopulmonary Resuscitation and Systemic Thrombolysis for Presumed Pulmonary Embolism

Abstract Introduction Mechanical cardiopulmonary resuscitation (CPR) devices provide consistent chest compressions and alleviate rescuer fatigue but have been associated with increased risk of visceral and vascular injuries. When combined with systemic thrombolysis, these complications may become catastrophic. We report a fatal case of hepatic rupture and abdominal compartment syndrome following prolonged mechanical CPR and thrombolytic therapy administered for presumed massive pulmonary embolism. Case presentation A 48-year-old woman with recurrent venous thromboembolism, non-adherent to anticoagulation, presented in pulseless electrical activity arrest. Massive pulmonary embolism was suspected, and 100 mg intravenous alteplase was administered during CPR. Approximately 90 minutes of alternating manual and mechanical compressions (LUCAS device) were performed. During resuscitation, marked abdominal distension developed. Point-of-care ultrasound demonstrated free intraperitoneal fluid, and elevated bladder pressure confirmed abdominal compartment syndrome. Emergent bedside decompressive laparotomy evacuated a massive hemoperitoneum; however, diffuse ongoing hemorrhage persisted despite surgical control, consistent with thrombolysis-associated coagulopathy. The patient experienced recurrent cardiac arrest and expired despite aggressive transfusion and resuscitative efforts. Autopsy revealed a 13.5 × 0.4 cm hepatic capsular laceration with subcapsular hematoma and a non-occlusive pulmonary artery embolus in a left lower-lobe branch. Discussion Mechanical CPR devices, such as LUCAS and AutoPulse, generate uniform compressions but may impart focal mechanical stress on abdominal viscera, predisposing to laceration. Concurrent systemic thrombolysis potentiates hemorrhage by disrupting clot stabilization. Hepatic rupture, though rare, is among the most devastating mechanical CPR-related injuries. This case underscores the synergistic bleeding risk of mechanical compression and thrombolytic therapy and the importance of early recognition of abdominal compartment syndrome. Bedside ultrasonography is a crucial diagnostic adjunct when abdominal distension arises during resuscitation. Clinicians should exercise caution in combining mechanical CPR with thrombolysis, particularly during prolonged efforts. Conclusion This case highlights a fatal intra-abdominal hemorrhage secondary to combined mechanical CPR and thrombolytic therapy. Awareness of this complication is essential when balancing the benefits of mechanical compressions against the risk of visceral injury during thrombolysis for suspected pulmonary embolism. This abstract is funded by: None