• Matthew V Kiefer and Colin M Feeney.
• Department of Emergency Medicine, Alameda County Medical Center - Highland Hospital, Oakland, California.
• J Emerg Med. 2013 Nov 1;45(5):666-9.

BackgroundSubcutaneous emphysema is often a symptom of a serious pathologic condition but rarely requires direct treatment. Subcutaneous emphysema itself occasionally may interfere with effective cardiopulmonary resuscitation and require direct intervention.ObjectiveThe aim of this article is to present a case of subcutaneous emphysema during cardiac arrest and to describe a therapeutic technique that we call the "gills" procedure, as well as the background and rationale for this and other similar techniques.Case ReportA 56-year-old man sustained cardiac arrest in the setting of a perforated duodenal ulcer with massive subcutaneous emphysema and pneumomediastinum that interfered with effective cardiopulmonary resuscitation. A "gills" procedure consisting of bilateral skin incisions over the clavicles was performed, with the return of spontaneous circulation.ConclusionSubcutaneous emphysema and pneumomediastinum can cause tension physiology, impairing normal cardiovascular and pulmonary function. Only with release of this tension can normal cardiopulmonary function return. The gills procedure is one of several possible therapeutic options.Copyright © 2013 Elsevier Inc. All rights reserved.

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