01/15/2026
"A 54 year-old man with no past medical history was brought to hospital with cardiac sounding chest pain and an electrocardiogram revealing ST elevation in leads II, III and aVF. He was taken for immediate primary coronary intervention for an inferior segment elevation (ST) elevation myocardial infarction via right radial approach. During diagnostic imaging of his left mainstem artery, he suffered a Ventricular Fibrillation (VF) cardiac arrest on table. He had immediate CPR by hand and then the Lund University Cardiac Arrest System (LUCAS) device was used. He required a total of five shocks in order to restore spontaneous circulation. His total downtime was approximately 10 minutes. During CPR, coronary angiography continued and he was found to have a right coronary artery culprit lesion, which was successfully treated with primary percutaneous coronary intervention (drug-eluting stent). At the end of his procedure, arterial blood gases showed an Hb of 69 g/l, significantly lower than his admission Hb of 112 g/l. However, this was in the context of 3 l of IV fluid during the resuscitation and angiogram. Repeat formal laboratory blood tests were requested as well as cross-match.
He was then transferred to the intensive care unit for on-going post-resuscitation care. Within minutes of arrival to the intensive care unit, he became significantly more haemodynamically unstable, requiring large doses of vasopressor to maintain blood pressure. Repeat arterial blood gas testing revealed an Hb of 45 g/l, at which point a peri-arrest call was put out. Clinically, he had a clear chest, normal heart sounds but a distended abdomen. He received hypovolaemic shock treatment, with fluids and blood transfusion. A bedside FAST scan was conducted, in the setting of a patient with shock and acute abdominal distension after cardiopulmonary resuscitation. In the hepatorenal recess view, free fluid was observed in Morison’s space with a varying degree of echogenicity. This finding was highly suggestive of an acute intra-peritoneal bleed, and in the context of recent CPR, a liver laceration was suspected.
He was taken for immediate laparotomy, which revealed a grade III liver haematoma, according to the American Association for the Surgery of Trauma liver trauma classification (intra-parenchymal hematoma of more than 10 cm). A definitive primary hepatic surgical repair was performed, and the patient was transferred back to the intensive care unit for supportive care.
Despite the history of a cardiac arrest and peri-arrest a few hours later, with haemorrhagic shock from liver trauma, he showed good neurological signs on sedation hold in the intensive care unit. His organ support was gradually weaned off, and he was discharged from the intensive care unit 5 days after initial admission and from hospital 4 days later. Echocardiography showed globally preserved systolic function with an ejection fraction of 59% and mild diastolic dysfunction. He made a full functional neurological recovery." - excerpt
Source:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7243720/
Here is a guy of similar age who, unlike Ernie, actually was having a STEMI (widowmaker) heart attack. He coded and required resuscitation with a LUCAS device, similar to the Autopulse device they used on Ernie, which also caused trauma to the guy's liver. This guy survived because they got him to the hospital, ran the appropriate tests to check what was going on with his blood indicators, and was able to get him into quick surgery to repair a grade 3 liver hematoma (bruise) as a result. The hematoma was on the front (not the back) of the liver, which is where the cpr related injuries occur when they do. Ernie's was 8cm x 4cm on the back of his liver.
How many medically documented SIGNIFICANT GRADE 4 POSTERIOR LIVER LACERATIONS occur a a result of CPR or CPR device where there isnt any broken ribs?
0. There are none. Cpr and cpr devices only cause between .6-3% of all liver injuries, which are RARE, repeat RARE, potential effects of cpr... and when they do the injuries occur to the anterior (front), on the right lobe, or near the hepatic ligament. They are seldom lacerations or ruptures and nearly always hematomas, and are always accompanied with many broken ribs when compressions or the device are done correctly. When cpr related injuries do occur they are broken ribs, followed by liver...but the gap in between the two different injuries is significant. It is misrepresented that cpr related liver injuries as the second most frequent cpr injury means that it is common. No, it most certainly is not and all medical documentation repeatedly states liver trauma is rare from CPR.
Ernie's liver laceration was a tear 8 cm x 4 cm to the posterior, or back, of his liver. The number of broken ribs Ernie had? Zero. The 11th rib may have had a possible hair line fracture, but it was not officially considered or diagnosed as broken. Not at all the number of ribs required to be broken to compress the liver enough to injure it in that location. Ernie was also kept 45 minutes on the side of the road only 6 miles from the hospital where he could have received proper treatment, immediate surgery, and an almost guaranteed survival outcome.
There is a really misleading phrase passed around that the ambulance gives you the same care as an ER. No the hell it doesn't. Ambulances do not get diagnostic tests done such as imaging and labs, ambulances can not perform many procedures that hospitals can.
Trauma arrests can only be resuscitated when the trauma is treated.
Cardiopulmonary resuscitation (CPR) is often conducted with mechanical devices, such as Lund University Cardiac Arrest System in the setting of cardiac arrest during coronary catheterization, to enable effective chest compressions for a prolonged ...