Obstructive shock with mediastinal hematoma caused by chest compressions after successful primary percutaneous coronary intervention

Abstract A 75-year-old man with a history of hypertension was transferred to our hospital due to pulseless ventricular tachycardia. When return of spontaneous circulation was achieved, an electrocardiogram showed ST elevation in V1-4 leads. Successuful primary percutaneous coronary intervention was performed. However, on the next day, the patient’s systolic blood pressure dropped to 60 mmHg despite using high-dose inotropic agents. Echocardiography and chest computed tomography revealed large mediastinal hematoma. A diagnosis of obstructive shock caused by massive mediastinal hematoma was made. Emergency surgical evacuation of hematoma and hemostasis was successfully performed. Learning objective: In a case with cardiac arrest due to ST-segment elevation myocardial infarction, primary percutaneous coronary intervention is necessary after successful cardiopulmonary resuscitation. However, chest compressions may cause severe trauma and subsequently massive hemorrhage under high-dose antiplatelet use. Careful monitoring of hemodynamic parameters is necessary even after successful coronary revascularization.>