{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:19:48Z","timestamp":1760145588437,"version":"build-2065373602"},"reference-count":16,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T00:00:00Z","timestamp":1723420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background: Cardiopulmonary resuscitation (CPR) is performed in cardiac arrests. There exist life support guidelines for individuals in performing effective CPR. CPR-related bleeding and hemothoraces are rare. Intercostal artery rupture leading up to shock and respiratory compromise in such situations is rare. Here, we present a unique case with a management dilemma while discussing challenges and guidance to regional centers. Case presentation: A 49-year-old Caucasian male experienced an out-of-hospital cardiac arrest which required bystander cardiopulmonary resuscitation from a colleague prior to commencement of lysis protocol at the local hospital. Transfer was later arranged to the nearest cardiac catheterization laboratory where a rescue percutaneous coronary intervention was performed in the left anterior descending artery that required strict dual antiplatelet use. Beneath the shroud of these events was a life-threatening right-sided hemothorax from rupture of intercostal arteries that occurred during initial resuscitation. Astute recognition of this post-percutaneous coronary intervention resulted in eventual transfer of the patient to a tertiary center where the source and the collection of the bleed was addressed. The patient\u2019s took a great trajectory to improvement. Conclusions: A regional center poses many challenges and limitations. Massive bleeding from intercostal arteries leading to hemorrhagic shock and respiratory compromise from an expanding hemothorax post-CPR is rare. Post-percutaneous coronary intervention use of dual antiplatelets posed a management dilemma that prompted assistance from tertiary counterparts. Clinicians should be astute and quick in assessing and providing care.<\/jats:p>","DOI":"10.3390\/reports7030069","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T10:54:54Z","timestamp":1723546494000},"page":"69","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["CPR-Induced Life-Threatening Hemothorax in a Rescue PCI Patient: Case Report and Brief Challenges of Regional Centers"],"prefix":"10.3390","volume":"7","author":[{"given":"Vaikunthan","family":"Thanabalasingam","sequence":"first","affiliation":[{"name":"Coronary Care Unit & Cardiac Catheterisation Laboratory, Department of Cardiology, Mackay Base Hospital, Mackay, QLD 4740, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1464-4315","authenticated-orcid":false,"given":"Clement","family":"Tan","sequence":"additional","affiliation":[{"name":"Coronary Care Unit & Cardiac Catheterisation Laboratory, Department of Cardiology, Mackay Base Hospital, Mackay, QLD 4740, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chaminda","family":"Sella Kapu","sequence":"additional","affiliation":[{"name":"Coronary Care Unit & Cardiac Catheterisation Laboratory, Department of Cardiology, Mackay Base Hospital, Mackay, QLD 4740, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark Daniel","family":"Higgins","sequence":"additional","affiliation":[{"name":"Coronary Care Unit & Cardiac Catheterisation Laboratory, Department of Cardiology, Mackay Base Hospital, Mackay, QLD 4740, Australia"},{"name":"The Prince Charles Hospital, Brisbane, QLD 4740, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhihua","family":"Zhang","sequence":"additional","affiliation":[{"name":"Coronary Care Unit & Cardiac Catheterisation Laboratory, Department of Cardiology, Mackay Base Hospital, Mackay, QLD 4740, Australia"},{"name":"College of Medicine and Dentistry, James Cook University, Townsville, QLD 4740, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.ejfs.2015.07.005","article-title":"Complications of cardiopulmonary resuscitation in non-traumatic cases and factors affecting complications","volume":"6","author":"Toygar","year":"2016","journal-title":"Egypt. J. Forensic Sci."},{"key":"ref_2","first-page":"5243105","article-title":"Intra-Abdominal Hemorrhage following Cardiopulmonary Resuscitation: A Report of Two Cases","volume":"2018","author":"Koutserimpas","year":"2018","journal-title":"Case Rep. Emerg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1001\/jamacardio.2019.2838","article-title":"Push Hard, Push Fast, Do Not Stop\u2014Optimal Chest Compression Rate and Depth","volume":"4","author":"Cone","year":"2019","journal-title":"JAMA Cardiol."},{"key":"ref_4","first-page":"81","article-title":"Rupture of a left internal mammary artery during cardiopulmonary resuscitation","volume":"29","author":"Patel","year":"2016","journal-title":"Proc (Bayl. Univ. Med. Cent.)"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ai, C., Lv, X., Qi, X., and Tang, H. (2022). Case report: Right coronary artery rupture\u2014A rare complication of cardiopulmonary resuscitation. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1042593"},{"key":"ref_6","unstructured":"Desai, H.H., and Pendleton, K. (2022). Intercostal Artery Damage Secondary to Chest Compression: A Lethal Cardiopulmonary Resuscitation Complication. B42 Cardiac and Pulmonary Cases, American Thoracic Society."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1437.e1","DOI":"10.1016\/j.ajem.2014.04.019","article-title":"Life-threatening hemothorax due to azygos vein rupture after chest compression during cardiopulmonary resuscitation","volume":"32","author":"Yang","year":"2014","journal-title":"Am. J. Emerg. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.jclinepi.2017.04.026","article-title":"CARE guidelines for case reports: Explanation and elaboration document","volume":"89","author":"Riley","year":"2017","journal-title":"J. Clin. Epidemiol."},{"key":"ref_9","first-page":"279","article-title":"Bystander-initiated chest compression-only CPR is better than standard CPR in out-of-hospital cardiac arrest","volume":"2","author":"Cabrini","year":"2010","journal-title":"HSR Proc. Intensive Care Cardiovasc. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s00134-008-1255-9","article-title":"Frequent and rare complications of resuscitation attempts","volume":"35","author":"Buschmann","year":"2009","journal-title":"Intensive Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e21685","DOI":"10.1097\/MD.0000000000021685","article-title":"Computed tomographic findings of chest injuries following cardiopulmonary resuscitation: More complications for prolonged chest compressions?","volume":"99","author":"Jang","year":"2020","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/CPM.0000000000000343","article-title":"Hemothorax: A Review of the Literature","volume":"27","author":"Zeiler","year":"2020","journal-title":"Clin. Pulm. Med."},{"key":"ref_13","unstructured":"Shahoud, J.S., Kerndt, C.C., and Burns, B. (2024). Anatomy, Thorax, Internal Mammary (Internal Thoracic) Arteries. StatPearls, StatPearls Publishing LLC."},{"key":"ref_14","first-page":"116","article-title":"Application of Ultrasonography and Radiography in Detection of Hemothorax; a Systematic Review and Meta-Analysis","volume":"4","author":"Yousefifard","year":"2016","journal-title":"Emergency"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1055\/s-0042-1753482","article-title":"Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma","volume":"39","author":"Higgins","year":"2022","journal-title":"Semin. Interv. Radiol."},{"key":"ref_16","unstructured":"Pumarejo Gomez, L., and Tran, V.H. (2024, April 21). Hemothorax. [Updated 8 August 2023], StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538219\/."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/7\/3\/69\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:35:12Z","timestamp":1760110512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/7\/3\/69"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,12]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["reports7030069"],"URL":"https:\/\/doi.org\/10.3390\/reports7030069","relation":{},"ISSN":["2571-841X"],"issn-type":[{"type":"electronic","value":"2571-841X"}],"subject":[],"published":{"date-parts":[[2024,8,12]]}}}