Considerations on Liver Injuries Caused by CPR Case Presentation

Abstract

Cardiac arrest is a life-threatening condition which requires fast maneuvers for saving the victim's life. Cardio-pulmonary resuscitation (CPR) is one of the easiest and handiest maneuver which proved many times to be savior even though sometimes it could worsen the victim's prognosis. In this paper the authors present the case of a 75-year old male, with a significant medical history and long term thrombolytic treatment who suffered a witnessed cardiac arrest. The emergency team who arrived at the victim's home initiated the CPR and transported him to the hospital. The electrocardiogram showed inferior-lateral acute myocardial infarction and the cardiologist in the emergency room decided to transfer him to another hospital for specialized treatment. Despite the fact that the CPR was continued in the ambulance in order to maintain the cardiac activity, the blood pressure decreased gradually and he died couple of hours later. Internal examination at the autospy revealed multiple injuries caused by the cardiac massage: rib and sternum fractures, massive intraperitoneal bleeding, liver laceration and contusion. This paper brings to the attention of the physicians the issue of the iatrogenic injuries following the CPR and the possibility for these injuries to contribute to thanatogenesis. The authors also analyze the factors influencing the quality of the life-saving procedures and the role of the pathologist in establishing the correct cause of death taking into the gravity of the CPR related injuries.

Resuscitation artefact confirmed by postmortem angiography. Case report

“…Liver lesions mostly occur in the form of a rupture and the reason for its more common occurrence on the left side is the fact that it corresponds to the area of focus in resuscitative chest compression and its relation to the liver anatomy [3,6,8]. Chest compression after rib and sternum fractures may affect the abdominal organs [9]. In our case the liver injury was observed on the left side closely neighbouring the rib fractures.…”

Cardiopulmonary Resuscitated Complications Encountered in Forensic Autopsy Cases: A 5-Year Retrospective Analysis in Ramathibodi Hospital

“…Similar assumptions are adopted by Martin et al 17 in a case study of patients with liver lacerations stemming from CPR. Contrary to this, Ioan et al 16 found that even when AHA guidelines were strictly followed in administering CPR, injuries and specifically liver lacerations were still found.…”

“…Previous studies have indicated that internal organs may sustain injury during administration of CPR which comprise injuries of the thoracic wall, ribs, sternum, as well as organs located in chest area, e.g. pneumothorax, lung laceration [3][4][5][6][7][8][9][10][11][12][13][14][15] , abdominal organs especially the liver and spleen laceration [16][17][18][19] , and even the spinal cord have been reported. 20 In past autopsies conducted to determine a cause of death, it has been found that similarities exist between internal organ injuries sustained from CPR and those received from accidents or bodily abuse, which often complicates clear indication of cause and circumstance of death.…”