The significance of the postmortem discovery of gastric contents in the air passages

Pulmonary aspiration of gastric contents and the sudden infant death syndrome

“…Histological evidence in the lungs that resuscitation had been applied was found in almost all cases and therefore we cannot comment on the suggested role of resuscitation in promoting entry of gastric material into the respiratory passages. Our finding of a higher incidence of aspiration at autopsies performed after the day of death compared with those conducted on the same day might be time related, that is, from continuing bacterial proliferation bringing less severe aspiration into the diagnostic range (modified strongly but variably by body refrigeration), or due to more body movements during post‐mortem handling (although Byard 12 was unable to duplicate in infants the previous observations on the effects of body movements in adult deaths 13 ). However, we found no significant association of aspiration with four other measures of time to post‐mortem when used as continuous variables.…”

Pulmonary aspiration of gastric contents and the sudden infant death syndrome

“…Histological evidence in the lungs that resuscitation had been applied was found in almost all cases and therefore we cannot comment on the suggested role of resuscitation in promoting entry of gastric material into the respiratory passages. Our finding of a higher incidence of aspiration at autopsies performed after the day of death compared with those conducted on the same day might be time related, that is, from continuing bacterial proliferation bringing less severe aspiration into the diagnostic range (modified strongly but variably by body refrigeration), or due to more body movements during post‐mortem handling (although Byard 12 was unable to duplicate in infants the previous observations on the effects of body movements in adult deaths 13 ). However, we found no significant association of aspiration with four other measures of time to post‐mortem when used as continuous variables.…”

Resolving ambiguities in SUDEP classification

“…Stomach contents can be found in the airways at autopsy in deaths of all causes and manners due to (1) choking on food (food bolus identified in the larynx, trachea, or bronchi), (2) antemortem regurgitation causing reactive changes (eg, necrosis, inflammation) in airway lining, (3) agonal reflux (usually too short to cause reactive airways changes), and (4) postmortem passive transfer of stomach contents (no reactive airway changes) . Distinguishing agonal/incidental aspiration and postmortem passive transfer from a lethal aspiration may be impossible solely on pathological data .…”

“…Distinguishing agonal/incidental aspiration and postmortem passive transfer from a lethal aspiration may be impossible solely on pathological data . A witnessed aspiration, death suddenly while eating, or a food bolus in the airways are key; otherwise, aspiration as COD remains speculative …”

Regurgitation and pulmonary aspiration during cardio-pulmonary resuscitation (CPR) with a laryngeal tube: A pilot crossover human cadaver study

“…[30] In routine medico-legal autopsies, aspiration of gastric contents are observed in up to 25% of all cases (independent of the cause of death). [31] Furthermore, the timing of pulmonary aspiration in outpatients given CPR ranges from before CPR is initiated, during airway intervention (e.g. by a possible vomiting stimulus), during CPR after airway intervention (as in our study), or even thereafter during hospitalization.…”

Pulmonary aspiration of gastric contents and the sudden infant death syndrome

“…Histological evidence in the lungs that resuscitation had been applied was found in almost all cases and therefore we cannot comment on the suggested role of resuscitation in promoting entry of gastric material into the respiratory passages. Our finding of a higher incidence of aspiration at autopsies performed after the day of death compared with those conducted on the same day might be time related, that is, from continuing bacterial proliferation bringing less severe aspiration into the diagnostic range (modified strongly but variably by body refrigeration), or due to more body movements during post‐mortem handling (although Byard 12 was unable to duplicate in infants the previous observations on the effects of body movements in adult deaths 13 ). However, we found no significant association of aspiration with four other measures of time to post‐mortem when used as continuous variables.…”

Resolving ambiguities in SUDEP classification

“…Stomach contents can be found in the airways at autopsy in deaths of all causes and manners due to (1) choking on food (food bolus identified in the larynx, trachea, or bronchi), (2) antemortem regurgitation causing reactive changes (eg, necrosis, inflammation) in airway lining, (3) agonal reflux (usually too short to cause reactive airways changes), and (4) postmortem passive transfer of stomach contents (no reactive airway changes) . Distinguishing agonal/incidental aspiration and postmortem passive transfer from a lethal aspiration may be impossible solely on pathological data .…”

“…Distinguishing agonal/incidental aspiration and postmortem passive transfer from a lethal aspiration may be impossible solely on pathological data . A witnessed aspiration, death suddenly while eating, or a food bolus in the airways are key; otherwise, aspiration as COD remains speculative …”

Regurgitation and pulmonary aspiration during cardio-pulmonary resuscitation (CPR) with a laryngeal tube: A pilot crossover human cadaver study

“…[30] In routine medico-legal autopsies, aspiration of gastric contents are observed in up to 25% of all cases (independent of the cause of death). [31] Furthermore, the timing of pulmonary aspiration in outpatients given CPR ranges from before CPR is initiated, during airway intervention (e.g. by a possible vomiting stimulus), during CPR after airway intervention (as in our study), or even thereafter during hospitalization.…”

Pulmonary aspiration of gastric contents and the sudden infant death syndrome

“…Histological evidence in the lungs that resuscitation had been applied was found in almost all cases and therefore we cannot comment on the suggested role of resuscitation in promoting entry of gastric material into the respiratory passages. Our finding of a higher incidence of aspiration at autopsies performed after the day of death compared with those conducted on the same day might be time related, that is, from continuing bacterial proliferation bringing less severe aspiration into the diagnostic range (modified strongly but variably by body refrigeration), or due to more body movements during post‐mortem handling (although Byard 12 was unable to duplicate in infants the previous observations on the effects of body movements in adult deaths 13 ). However, we found no significant association of aspiration with four other measures of time to post‐mortem when used as continuous variables.…”

Resolving ambiguities in SUDEP classification

“…Stomach contents can be found in the airways at autopsy in deaths of all causes and manners due to (1) choking on food (food bolus identified in the larynx, trachea, or bronchi), (2) antemortem regurgitation causing reactive changes (eg, necrosis, inflammation) in airway lining, (3) agonal reflux (usually too short to cause reactive airways changes), and (4) postmortem passive transfer of stomach contents (no reactive airway changes) . Distinguishing agonal/incidental aspiration and postmortem passive transfer from a lethal aspiration may be impossible solely on pathological data .…”

“…Distinguishing agonal/incidental aspiration and postmortem passive transfer from a lethal aspiration may be impossible solely on pathological data . A witnessed aspiration, death suddenly while eating, or a food bolus in the airways are key; otherwise, aspiration as COD remains speculative …”

Regurgitation and pulmonary aspiration during cardio-pulmonary resuscitation (CPR) with a laryngeal tube: A pilot crossover human cadaver study

“…[30] In routine medico-legal autopsies, aspiration of gastric contents are observed in up to 25% of all cases (independent of the cause of death). [31] Furthermore, the timing of pulmonary aspiration in outpatients given CPR ranges from before CPR is initiated, during airway intervention (e.g. by a possible vomiting stimulus), during CPR after airway intervention (as in our study), or even thereafter during hospitalization.…”