Abstract
Cardiopulmonary resuscitation (CPR)is a life-saving procedure that can also cause many life-threatening injuries to patients. The complications that can arise from the application of CPR are confronted by the existing legal system as a medical error and since forensic pathologists often encounter various types of CPR-related injuries during autopsies, they must be able to distinguish between CPR-related injuries and those caused by other factors. The aim of the present study was to analyze the findings of autopsy reports of patients who received CPR to determine the frequency of its related life-threatening injuries and to determine the possible factors that affect and increase the risk of these injuries. The study included 58 non-traumatic death cases that had undergone CPR and CPR-related injuries were determined based on X ray CT interpretation reports. The results concluded that the advanced life support was provided in the vast majority of cases (70.7%). The mean duration of CPR provided was (22.0 ± 12.35 & 21.5 ± 13.56 min.) in males and females respectively and defibrillation procedure took place in 79.3% of cases.The most common complications detected were the thoracic cage complications where the costal injuries were the most frequent complications in 48.4% of cases, mid-clavicular rib fracture was the most frequent one and 66.7% of sternal fractures were detected at the level of the third rib. Males were more susceptible to rib and sternal fractures than females. The factors of age, gender and CPR duration were found to have an effect on the increased risk of life-threatening injuries. The risk of injury increases especially when the compression depth exceeded 6 cm. and CPR duration exceeds 30 min. The present study concluded that CPR complications may decrease the patient’s chance of survival and can cause death by itself. The present study recommend detailed post-mortem studies on CPR related life-threatening injuries on a trial of their prevention.
Highlights
Sudden death from cardiac arrest is a major medical issue and one of the biggest people’s fears
Table (2) shows the specifications regarding cardiopulmonary resuscitation (CPR) provided to the study group, in which basic life support alone was performed in 17 (29.3%) cases and advanced life support was provided in the vast majority of cases (70.7%)
A positive association was detected between mean chest compression depth and the CPR-related injuries, as when the compression depth increases the risk of injury increases especially when the chest compression depth exceeded 6 cm
Summary
Sudden death from cardiac arrest is a major medical issue and one of the biggest people’s fears. CPR is an emergency procedure involving external chest compression and artificial ventilation that aims to restore oxygenated blood flow to the brain and heart in individuals with cardiac arrest (Olds et al, 2015) while it can cause many life-threatening injuries to patients (Hashimoto et al, 2007). CPR contains a significant violation risk with forensic relevance, for the patient and the physician (Buschmann and Tsokos, 2009) and CPR-related injuries are confronted by the existing legal system as a medical error, as in the performance of any medical procedure with adverse outcome (Deliligka et al, 2016). Since forensic pathologists often encounter various types of CPR-related injuries during autopsies, they must be able to distinguish between them and those caused by other factors (Hashimoto et al, 2007)
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