Cardiac arrest caused by tension pneumomediastinum in a Boerhaave syndrome patient.

This report presents a 23-year-old man with esophageal perforation, tension pneumomediastinum, and subsequent cardiorespiratory arrest. Initial resuscitation by cervical and subxiphoid mediastinotomy was ineffective. Bedside decompression of the posterior mediastinum through the esophageal hiatus of the diaphragm resulted in immediate return of a normal sinus rhythm and noncompromised mechanical ventilation.