# CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional Centers

## TL;DR

A rare case of life-threatening hemothorax caused by CPR in a patient undergoing rescue PCI highlights challenges for regional centers.

## Contribution

This case report highlights the rare complication of intercostal artery rupture during CPR and its management in a regional setting.

## Key findings

- CPR can cause intercostal artery rupture leading to hemothorax and shock.
- Dual antiplatelet use after PCI complicates management of CPR-induced bleeding.
- Timely recognition and transfer to a tertiary center improved patient outcomes.

## Abstract

Background: Cardiopulmonary resuscitation (CPR) is performed in cardiac arrests. There exist life support guidelines for individuals in performing effective CPR. CPR-related bleeding and hemothoraces are rare. Intercostal artery rupture leading up to shock and respiratory compromise in such situations is rare. Here, we present a unique case with a management dilemma while discussing challenges and guidance to regional centers. Case presentation: A 49-year-old Caucasian male experienced an out-of-hospital cardiac arrest which required bystander cardiopulmonary resuscitation from a colleague prior to commencement of lysis protocol at the local hospital. Transfer was later arranged to the nearest cardiac catheterization laboratory where a rescue percutaneous coronary intervention was performed in the left anterior descending artery that required strict dual antiplatelet use. Beneath the shroud of these events was a life-threatening right-sided hemothorax from rupture of intercostal arteries that occurred during initial resuscitation. Astute recognition of this post-percutaneous coronary intervention resulted in eventual transfer of the patient to a tertiary center where the source and the collection of the bleed was addressed. The patient’s took a great trajectory to improvement. Conclusions: A regional center poses many challenges and limitations. Massive bleeding from intercostal arteries leading to hemorrhagic shock and respiratory compromise from an expanding hemothorax post-CPR is rare. Post-percutaneous coronary intervention use of dual antiplatelets posed a management dilemma that prompted assistance from tertiary counterparts. Clinicians should be astute and quick in assessing and providing care.