Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation

Ondruschka, Benjamin; Baier, Christina; Bernhard, Michaël; Buschmann, C.; Dreßler, Jan; Schlote, Julia; Zwirner, Johann; Hammer, Niels

doi:10.1007/s12024-018-0044-1

Cited by 14 publications

(6 citation statements)

References 44 publications

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“…According to the literature, PFE after CPR related to rib fractures is usually mild (score 1 of Falzi) and not considered a factor that can limit the effectiveness of the resuscitation [ 6 , 7 ]. However, in our study, we detected an important PFE (score 2 of Falzi) in about 30% of children that received an intraosseous infusion.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies showed that PFE can also be found without bone fractures, in cases with corticosteroid treatment, fatty liver, diabetes, osteomyelitis, burns, liposuction, cardiopulmonary bypass surgery, decompression sickness, parenteral lipid infusion, hemorrhagic pancreatitis, carbon tetrachloride poisoning, massive hepatic necrosis with fatty liver, heat exposure, and sickle-cell disease or in cases of diffuse soft tissue contusions [2][3][4][5]. In the end, it is known that PFE can be detected after cardio-pulmonary resuscitation (CPR) by external cardiac massage with rib cage fractures [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Fat embolism after intraosseous catheters in pediatric forensic autopsies

2022

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In our center, we performed the autopsy of a child who died from drowning and presented, at autopsy, a major pulmonary fat embolism (PFE). A cardiopulmonary resuscitation (CPR) was performed, including infusion by intraosseous catheter (IIC). No other traumatic lesions and diseases classically related to a risk of PFE were detected. According to some animal studies, we considered the IIC as the only possible cause for PFE. However, we could not find literature to confirm this hypothesis in humans, especially in a pediatric population. To verify the occurrence of PFE after IIC in a pediatric population, we retrospectively selected 20 cases of pediatric deaths autopsied in our center, in which a CPR was performed, without bone fractures or other possible causes of PFE: 13 cases with IIC (group A) and 7 cases without IIC (group B). Several exclusion criteria were considered. The histology slides of the pulmonary tissue were stained by Oil Red O. PFE was classified according to the Falzi scoring system. In group A, 8 cases showed PFE: 4 cases with a score 1 of Falzi and 4 cases with a score 2 of Falzi. In group B, no case showed PFE. The difference between the two groups was statistically significant. The results of our study seem to confirm that IIC can lead to PFE in a pediatric population and show that the PFE after IIC can be important (up to score 2 of Falzi). To the best of our knowledge, our study is the first specifically focused on the occurrence of PFE after IIC in a pediatric population by using autoptic data.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fat embolism after intraosseous catheters in pediatric forensic autopsies

2022

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“…They report the average total duration of CPR with CPR injuries as 43.9 ± 24.8 minutes ( P < .001). 7,8 We decided to utilize this time as the maximum CPR duration for inclusion criteria by rounding this value up to 45.0 minutes for ease of data collection in all studies.…”

Section: Methodsmentioning

confidence: 99%

Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

Chun

Zhang

Toraih

et al. 2021

The American Surgeon™

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Purpose Mechanical chest compression has been shown to be equivalent to manual chest compression in providing survival benefits to patients experiencing cardiac arrest. There has been a growing need for a contemporary review of iatrogenic injuries caused by mechanical in comparison with manual chest compression. Our study aims to analyze the studies that document significant life-threatening iatrogenic injuries caused by mechanical and manual chest compression. Methods A systematic review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. All studies published after January 1st, 2000 were reviewed using inclusion/exclusion criteria and completed by May 2020. A total of 7202 patients enrolled in 15 studies were included in our meta-analysis. Results Significant life-threatening iatrogenic injuries had higher odds of occurring when mechanical chest compression was used compared to manual chest compression, especially for hemothorax and liver lacerations. Mechanical chest compression involves consistently deeper compression depths compared to manual chest compression, potentially resulting in more injuries. In the mechanical chest compression cohort, chest wall fractures had the highest incidence rate (55.7%), followed by sternal fracture (28.3%), lung injuries (3.7%), liver (1.0%), and diaphragm (.2%) lacerations. Conclusions Mechanical chest compression was associated with more iatrogenic injuries as compared to manual chest compression. Further research is needed to define the appropriate application of mechanical in comparison with manual chest compression in different scenarios. Levels of provider training, different mechanical chest compression device types, patient demographics, and compression duration/depth may all play roles in influencing outcomes.

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“…There are case reports of pediatric patients who died after fat embolism caused by the insertion of the intraosseous catheter [ 41 ]. Cardiopulmonary resuscitation (CPR) is a well-known cause of fat embolism, due to bone injury, but also trauma to subcutaneous tissue [ 42 ].…”

Section: Fat Embolismmentioning

confidence: 99%

Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences

Sîrbu

Șorodoc

Floria

et al. 2023

JPM

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Nontrombotic pulmonary embolism represents the embolization of different types of materials (cells, organisms, gas, foreign material) into pulmonary circulation. The disease is uncommon, and clinical presentation together with laboratory findings are nonspecific. Its pathology is usually misdiagnosed based on imaging findings as pulmonary thromboembolism, but the correct diagnosis is essential because different therapeutic approaches are required. In this context, knowledge of the risk factors associated with nontrombotic pulmonary embolism and specific clinical symptoms is fundamental. Our objective was to discuss the specific features of the most common etiologies of nontrombotic pulmonary embolism, gas, fat, amniotic fluid, sepsis and tumors, to provide assistance for a rapid and correct diagnosis. Because the most common etiologies are iatrogenic, knowledge of the risk factors could be an important tool for prevention or rapid treatment if the disease develops during different procedures. The diagnosis of nontrombotic pulmonary embolisms represent a laborious challenge, and endeavors should be made to prevent development and increase awareness of this disease.

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Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation

Cited by 14 publications

References 44 publications

Fat embolism after intraosseous catheters in pediatric forensic autopsies

Fat embolism after intraosseous catheters in pediatric forensic autopsies

Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences

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