心臓マッサージに起因する心タンポナーデの1例

Cardiac Tamponade by Chest Compression at Cardiopulmonary Resuscitation；Report of a Case

はじめに　心肺蘇生時の圧迫による胸骨骨折断端が原因で発症する心臓損傷はまれであり，剖検症例報告で散見されるのみである．われわれは，前述の機序による右室損傷症例を経験したので報告する．

We report a case of right ventricular rupture caused by sternal bone fracture following chest compression at cardiopulmonary resuscitation （CPR）. A 68-year-old man presented with syncope and was referred to our hospital in an ambulance. Ventricular fibrillation was confirmed by electrocardiography （ECG）, and CPR was performed with chest compression. He was resuscitated and his ECG showed ST elevation. He immediately underwent percutaneous coronary intervention to the right coronary #1 which was subtotally occluded. Thereafter, massive cardiac tamponade was noted by echocardiography, and coronary injury or left ventricle （LV） rupture was suspected. Emergency exploratory surgery was performed through median sternotomy. Laceration of the right ventricle corresponding to the sternal bone fracture was found intraoperatively. We repaired the injury and he was discharged without complication. The possibility of iatrogenic cardiac tamponade should be considered when a resuscitated patient by chest compression develops hypotension.