Post-CPR right coronary artery rupture in a patient with anaphylaxis-induced cardiac arrest: a case report

Anaphylactic shock is a life-threatening event characterized by severe inflammatory response and profound hemodynamic instability, which can progress to cardiac arrest. Cardiopulmonary resuscitation (CPR) is a life-saving intervention in the event of cardiac arrest but may cause severe mechanical injury. Coronary artery injury is a rare complication which is not fully discussed in literatures. We present a case of a 64-year-old male who suffered anaphylactic shock to 4% succinylated gelatin with cardiac arrest. Manual CPR was performed, followed by the development of severe cardiac tamponade due to rupture of the conus branch of the right coronary artery and a sternal fracture. Prompt diagnosis via transesophageal echocardiography (TEE) and emergency thoracotomy under cardiopulmonary bypass led to successful repair. The patient recovered uneventfully and underwent the original elective surgery 6 months later without complications. This case highlights the successful resuscitation and multidisciplinary management of a rare CPR-related complication, right coronary artery rupture with cardiac tamponade, in a patient with anaphylaxis-induced cardiac arrest. And in unstable patients after return of spontaneous circulation, early TEE should be considered to promptly identify evolving mechanical complications.