Nontraumatic postmortem computed tomographic demonstration of cerebral gas embolism following cardiopulmonary resuscitation

Abstract

The aim of this study was to investigate cerebral gas embolism (GE) on nontraumatic postmortem CT (PMCT), regarding its frequency, location (arterial or venous), and causes. Our subjects were 404 nontraumatically deceased patients who had been in a state of cardiopulmonary arrest on arrival at our emergency room. PMCT was performed within 2 h of the confirmation of death. Cardiopulmonary resuscitation (CPR) was performed on 387 of the 404 subjects; and of these, cerebral GE was detected in 29 (7.5%) subjects (3 arterial, 25 venous, 1 undeterminable). Cerebral GE was not noted in the other 17 of the 404 subjects who did not undergo CPR. However, there was no significant difference in the incidence of cerebral GE between the subjects who underwent CPR and those who did not. The mechanism of cerebral arterial GE was presumed due to pulmonary barotrauma and/or paradoxical embolism, while the thoracic pump theory was suggested to explain the cerebral venous GE. Cerebral arterial/venous GE is found in CPR cases on nontraumatic PMCT.