What question did this study set out to answer?

This study aims to highlight the rare but severe cardiac injuries caused by CPR, particularly after ECPR.

June 12, 2026

ID:159 FC-D09-8 Sudden Hemodynamic Collapse Post-ROSC on ECPR: Unmasking a Fatal CPR-Related Cardiac Trauma

CTChang Chih TsaiChi Mei Medical Center CWChen Wei WuChi Mei Medical Center

Key Points

This study aims to highlight the rare but severe cardiac injuries caused by CPR, particularly after ECPR.
Detailed case analysis of a 60-year-old man suffering from cardiac arrest and treated with ECPR.
Utilized bedside ultrasound to diagnose post-ROSC complications, including cardiac tamponade.
Performed emergent surgery following identification of a ruptured right coronary artery.
The patient developed severe hemodynamic instability 53 minutes post-ROSC, requiring rapid intervention.
Emergency pericardiocentesis revealed over 500mL of bloody fluid and confirmed cardiac tamponade.
Surgical repair of the ruptured right coronary artery was performed successfully, and the patient was discharged after 105 days.

Abstract

Background: Cardiopulmonary resuscitation (CPR) is essential for sudden cardiac arrest. For refractory cases, extracorporeal cardiopulmonary resuscitation (ECPR) plays a crucial role in providing critical hemodynamic support and improving survival. However, CPR may cause severe complications. While skeletal fractures are common, CPR-induced cardiac injuries, such as coronary artery rupture, are exceedingly rare and typically detected post-mortem. Clinical course: A 60-year-old man collapsed from sudden cardiac arrest presenting with refractory VT. He received chest compressions, defibrillation, anti-arrhythmic agents, and ECPR. Return of spontaneous circulation (ROSC) occurred at 56 minutes. However, 53 minutes post-ROSC, he developed severe hemodynamic instability. Bedside ultrasound revealed new cardiac tamponade with right ventricular (RV) collapse. Following emergency pericardiocentesis (>500mL bloody fluid drained), emergent surgery was performed. Surgeons discovered a ruptured right coronary artery (RCA) and an RV anterior wall injury directly beneath a sharp sternal fracture, confirming a CPR-induced etiology. The lesions were successfully repaired under extracorporeal mechanical support, and the patient was discharged 105 days post-admission. Discussion: Post-resuscitation deterioration requires rapid evaluation for reversible causes, including cardiac tamponade. The exact anatomical match between the fractured sternal edge and the RCA/RV lesions confirmed a CPR-related trauma. Unlike most cases which are only identified at autopsy, ECPR stabilized his hemodynamics long enough for a definitive diagnosis and intervention. Because CPR-related blunt cardiac injuries are easily overlooked but potentially fatal, early targeted point-of-care ultrasound is a critical diagnostic tool for post-arrest patients. Conclusion: While ECPR introduces potential complications from cannulation and extracorporeal circulation, physicians must also remain vigilant for life-threatening injuries caused by the initial CPR. If the clinical condition rapidly deteriorates post-ROSC, routine bedside ultrasound is highly recommended for the immediate detection and management of these rare but fatal complications.

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