Right Ventricular Rupture Caused by Prolonged Cardiopulmonary Resuscitation after Sudden Cardiac Arrest

A 46-year-old male arrived at the emergency department with acute dyspnea. On the way to the hospital, heart massage was performed in the ambulance due to asystole on electrocardiography. After 2 hr of resuscitation, sinus rhythm was restored. Extracorporeal life support and an intra-aortic balloon pump were applied due to cardiogenic shock, but the patient showed sustained hypotension. Echocardiography showed moderate pericardial effusion with physiological evidence of cardiac tamponade; emergency pericardiocentesis was performed, which produced bloody pericardial fluid. An explorative sternotomy revealed a massive hematoma in the mediastinum and right ventricular (RV) free wall rupture. After primary repair, echocardiography showed improved left ventricular systolic function and the patient was stable clinically. This case presents RV free wall rupture as an unusual complication of prolonged heart massage. Heart rupture should be considered in hemodynamically unstable patients after prolonged heart massage. (Korean J Med 2015;88:434-437)