Tension pneumothorax, areversible cause of cardiac arrest. [Greek]
Authors: Pezikoglou I, Fyntanidou B, Foroulis Ch, Amaniti A, Alexiou Ι, Kyparissa M, Palaska E, Grosomanidis V
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Pneumothorax is a collection of air in the pleural space between the lungs and the chest wall and depending on its cause it could be either spontaneous or traumatic. Tension Pneumothorax (TPT) can be a cause of cardiac arrest (CA) or might be a complication after chest compressions. According to the 2015 European Resuscitation Council guidelines on resuscitation, TP is considered one of the reversible causes of CA, which should be recognized and treated during cardiopulmonary resuscitation (CPR). A 61yrs old patient (ASA-PS:3, NYHA:2) was scheduled for a video-assisted mesothoracoscopy. The patient was a former smoker and suffered from hypertension and chronic obstructive pulmonary disease. He underwent an uneventful video-assisted mesothoracoscopy, was extubated in the operating theatre and was transferred to the High Dependency Unit. Approximately 40min later and after a prolonged cough episode, he experienced severe dyspnea, tachypnea, tachycardia, hypertension, SpO2 reduction and he became anxious. A bedside chest x-ray has been already performed before this episode but the image was not yet available to the physicians. Patient deteriorated very fast, he became agitated, experienced a severe blood pressure decrease, which was followed by CA. The initial CA rhythm was Pulseless Electrical Activity (PEA). CPR was initiated immediately with chest compressions, mask ventilation and intravenous administration of 1mg adrenaline. After endotracheal intubation it was impossible to ventilate the (intubated) patient with a bag-valve device. Esophageal Intubation was excluded since endotracheal intubation has been performed by an experienced consulting anesthesiologist and the direct laryngoscopy was easy and classified as Cormack-Lehane grade 1 and therefore tension pneumothorax was highly suspected. Immediately at this time point two chest tubes were inserted bilaterally without any interruption of the chest compressions. Air was expelled only from the right chest. CA rhythm remained PEA and Return of Spontaneous Circulation (ROSC) was achieved after 5min of CPR and without administration of a second adrenaline dose. After ROSC, patient was transferred to the Intensive Care Unit, where he was extubated the next day without any neurological deficits and thereafter he experienced an uneventful recovery. Pneumothorax is one of the possible complications of video-assisted mesothoracoscopy, while TPT is a reversible cause of CA. Recognition of CA, immediate CPR initiation and early diagnosis and treatment of TPT contributed to short CA-ROSC time and to the survival of this patient without any neurological impairment.