Shubhi Saxena

Intern Mentor

Ms. Ireland Pd. 1

8 October 2018

Aortic Dissection : A Rare and Fatal Complication of Cardiopulmonary Resuscitation?

Research Question:

Does Cardiopulmonary Resuscitation increase the risk for Aortic Dissection?

Hypothesis:

Prolonged Cardiopulmonary Resuscitation, although rarely, does increase the risk of Aortic

Dissection, especially when in presence of preexisting aortic or cardio issues.

Background/ History of the Issue:

Aortic Dissection is a serious condition in which the the inner layer of the aorta tears. The aorta

is the largest artery in the human body. It branches off the heart, beginning at the left ventricle,

and pumps oxygenated blood from the heart to the rest of the body. Blood can surge through the

intimal tear in the aorta and cause the middle and inner layers of the aorta to separate. If the

blood filled channel ruptures through the outside of the aortic wall, an Aortic dissection can be

fatal. Cardiopulmonary Resuscitation is a life-saving technique used in emergencies in which a

person’s breathing or heartbeat has stopped. CPR keeps oxygenated blood flowing throughout

the body. It is also blunt thoracic trauma to the chest that can cause skeletal chest injuries. A rare

but serious side effect of CPR is Aortic Dissection. Blunt Trauma Aortic Injury can be divided

into four severities: an intimal tear (which usually repairs on its own unless aggravated),

intramural hematoma (leakage of blood through the aortic wall), Pseudoaneurysm (when a blood

vessel wall is injured, and the blood is contained by the surrounding tissues), and Aortic rupture.

1
Aortic rupture, which is rapidly lethal, has been reported as consequence of both manual and

mechanical CPR.

Rationale:

The issue of Aortic Dissection being caused by CPR is important because CPR is a commonly

utilized technique for reintroducing blood flow. If Aortic Dissection could be a possible side

effect, the means or preparations for using CPR should be reevaluated. Aortic Dissection has a

mortality rate that increases 1% per hour initially, with half of the patients expected to be dead

within 3 days, and 80% within two weeks. 20% of patients pass away of Aortic Dissection before

reaching the hospital. If CPR can induce Aortic Dissection, and the survival rate for Aortic

Dissection is so low, there needs to be investigation into protocol to prevent this, or to at least

raise awareness of Aortic Dissection as a risk of CPR so that it can be encountered and fixed in

its initial stages.

Basis of Hypothesis:

I focused my hypothesis specifically on prolonged Cardiopulmonary resuscitation because most

of the case studies on patients who suffered Aortic Dissection as a result of Cardiopulmonary

Resuscitation underwent CPR of 60 minutes or longer. I also mentioned the preexisting aortic

and heart problems because most patients come into the hospital after suffering a heart attack,

and need CPR which, when paired with a irregular heartbeat, after a significant amount of time

can seriously injure the aorta. Previous aortic problems raise the risk for Aortic Dissection

because of the presumably already weak walls of the Aorta. In addition the case studies analyzed

thus far, have all alluded to the Aortic Dissection being culminated as a result of many factors,

such as a previous Intramural Hematoma or blunt thoracic trauma (such as from a car accident).

2
The accumulation of these many factors to cause an Aortic Dissection are rare, and so Aortic

Dissection is a rare but fatal consequence of CPR.

Operational Definitions:

● Blunt Thoracic Trauma: a usually serious injury caused by a blunt object or collision

with a blunt surface. CPR can be considered blunt trauma as it delivers blunt force

towards the chest in order to restart the heart.

● Aortic Wall: The Aortic wall has 3 layers: the intima, media, and adventitia. The

intima is the innermost layer; the media, the middle layer; the adventitia, the outer

later. The tearing of the Aorta is initiated in the intima and progresses as the intima

allows blood to leak into the media. This creates two passages for blood: a true

lumen, which is the normal passageway of blood, and a false lumen, the newly

created passageway.

Descriptors Used for Literature Search:

● Aortic Dissection

● Cardiopulmonary Resuscitation

● Chest compressions and Aortic injury

● Side effects of CPR

● Aortic Injury Causes