Delayed massive bleeding from minor splenic injury due to mechanical chest compression for cardiopulmonary resuscitation

BACKGROUND: Splenic injury due to chest compressions is a rare and fatal complication that occurs immediately after cardiopulmonary resuscitation. CASE PRESENTATION: Cardiopulmonary resuscitation was carried out using a mechanical chest compression device in a 74‐year‐old Japanese female patient who underwent cardiac arrest. Computed tomography postresuscitation revealed bilateral anterior rib fractures. Other traumatic findings were not observed. Coronary angiography revealed no new lesions; the cause of the arrest was hypokalemia. She received mechanical support with venoarterial extracorporeal membrane oxygenation and multiple antithrombotic agents. Her hemodynamic and coagulative condition became life‐threatening on day 4; abdominal ultrasound revealed massive bloody ascites. Only a minor splenic laceration was observed intraoperatively, despite massive bleeding. Furthermore, her condition stabilized after splenectomy and blood transfusion. Venoarterial extracorporeal membrane oxygenation was discontinued on day 5. CONCLUSION: In patients with postcardiac arrest, delayed bleeding due to minor visceral injury should be considered, particularly for coagulation abnormalities.