Chest compressions during cardiopulmonary resuscitation (CPR) can be traumatic. We report a rare complication of CPR in which the patient experienced 2 rib fractures associated with tension pneumothorax. An 83 year-old man with a history of chronic obstructive pulmonary disease (COPD) and chronic renal disease was accepted with respiratory insufficiency. In a few minutes, he developed hypotension, bradycardia, and hypoxia. As a consequence of cardiac arrest, basic life support was performed. It was realized that the left side of the chest had little movement while the right side was hyperexpanded. Chest radiograph showed a right sided pneumothorax. A 14G intravenous cannula was inserted through the second right intercostal space in the mid-clavicular line. Afterwards an intercostal tube was inserted in the same place. Nevertheless, the patient died approximately 30 hours after admission. Tension pneumothorax is a well known complication of intermittent-positive-pressure ventilation (IPPV) and chronic lung disease. Tension pneumothorax may be difficult to diagnose and therefore, maybe missed during a complex resuscitation attempt. Since diagnosis is difficult during ongoing resuscitation, either a chest tube or intercostal cutdown can be considered following needle thoracocentesis to exclude tension pneumothorax as a probable cause of refractory cardiac arrest in high-risk patients.
Key words: Cardiopulmonary resuscitation, tension pneumothorax, intensive care
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