LUNG HERNIATION: A RARE RESULT OF CPR

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: herniation as a result of cardiopulmonary resuscitation (CPR) is rare condition whereby the pleura-covered lung parenchyma protrudes through defect in chest wall. CASE PRESENTATION: A 70-year-old male with history end stage renal disease on dialysis and heart failure presented to hospital three weeks progressive dyspnea diagnosed pulmonary edema. He was started hemodialysis for volume removal. On day four, patient developed cardiac arrest, found be hemorrhagic shock, massive hemorrhage from his fistula. The underwent high quality compressions while receiving standard advanced life support transfusion protocol. After return spontaneous circulation control bleeding, right mass palpated. Imaging demonstrated multiple consecutive anterior rib costochondral junction fractures resulting flail large an associated moderate hemothorax. thoracostomy tube offered surgical fixation; however, patient's family decided pursue comfort measures. DISCUSSION: extremely entity first described association CPR 1986. Since then, there have been only seven cases after reported literature. Furthermore, occurrence chondrosternal disruption even more uncommon, such our chest. When providing high-quality compressions, traumatic injuries sternum ribs often unavoidable rate injury does not vary based medical training compressor nor factors age gender. However, certain comorbidities place patients at increased risk including COPD obesity. Chest drainage hemothorax may reduction herniated lung. Otherwise, early fixation should pursued it low morbidity excellent prognosis. There no consensus management concurrent Clinicians include differential recent trauma CPR, when confronted worsening respiratory symptoms or ventilatory mechanics, intervention necessary. CONCLUSIONS: phenomenon that especially aforementioned factors. We believe incidence this thoracic pathology will increase at-risk population continues rise thus emphasizing importance clinician recognition provide definitive treatment. REFERENCE #1: Batra AK. CPR. Crit Care Med. 1986;14(6):595-6. doi: 10.1097/00003246-198606000-00022. PMID: 3709206. #2: Deliliga, A., Chatzinikolaou, F., Koutsoukis, D. et al. Cardiopulmonary complications encountered forensic autopsy cases. BMC Emerg Med 19, 23 (2019). https://doi.org/10.1186/s12873-019-0234-5 #3: Allen GS, Fischer RP. Traumatic herniation. Annal Thoracic Surg. 1997;63(5):1455–6. 10.1016/s0003-4975(97)00109-4. DISCLOSURES: No relevant relationships by Andrew Deitchman, source=Web Response Jesse Liou, John Nawrocki,