Unexpected findings and complications at autopsy after cardiopulmonary resuscitation (CPR)

Bedell, S. E.

doi:10.1001/archinte.146.9.1725

Cited by 28 publications

(16 citation statements)

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“…In our pooled analysis, the incidence of post-resuscitation rib fractures was 31.2%, with a higher incidence noted for both suction cup based ACD-CPR devices and standard CPR followed by ACD-CPR compared to standard CPR alone (Table 3). 5–8, 10, 15, 16, 19–22, 25, 28, 33, 46, 48–56 Multiple rib fractures (29.2%), 8, 11, 16, 19, 51, 54 bilateral fractures, 54 and flail chest 21, 46, 51, 57 occurred frequently as well. Although the overall pooled incidence of flail chest was 1.7%, flail chest has been reported to occur at a rate of 5.6 per 100 survivors of CPR.…”

Section: Resultsmentioning

confidence: 99%

“…A broad spectrum of cardiac injuries have been observed including both contusions of the epi-, myo-, or endocardium (4.4%, 1.7%, and 3% respectively) 5–7, 9–11, 18, 26–31 and lacerations or chamber ruptures (0.6%) involving the right atrium, 13, 15, 23, 24 right ventricle, 13, 28, 32–34 left ventricle, 5, 12, 18, 25, 28 or locations not specified. 5, 14, 17 Cardiac rupture has been associated with thoracic wall injuries or myocardium weakened by ischemia.…”

Section: Resultsmentioning

confidence: 99%

“…58 Standard chest radiograph views with an additional oblique rib view, detected only 10% (8 of 83) of rib fractures found by chest wall ultrasound and after 3 weeks were positive in only 6 of 39 patients (15%) who had fractures detected by repeat chest wall ultrasound. 59 Other common chest wall injuries include separation of costochondral junction (0.5%), 8 clavicle fracture (0.3%), 8 lung herniation, 50, 60, 61 mediastinal (10.2%) 5, 6, 8, 28, 51 or subcostal bleeding (17.6%), 62 and hemothorax. 19, 20, 22, 50, 51, 56 …”

Section: Resultsmentioning

confidence: 99%

“…5, 6, 8, 10, 11, 16, 18–20, 33, 55 A common yet often unrecognized complication is pulmonary bone marrow or fat emboli which has a pooled incidence of 19.2% in autopsy series of CPR non-survivors. 5, 7, 16, 19, 21, 28, 46, 63 The clinical significance of this type of injury as well as the incidence amongst CPR survivors has not been clearly described.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries

et al. 2014

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OBJECTIVE The incidence of thoracic injuries resulting from cardiopulmonary resuscitation (CPR) is not well characterized. We describe a case in which a CPR-associated atrial rupture was identified with ultrasound and successfully managed in the intensive care unit with a bedside thoracotomy and atrial repair. We then describe a systematic review with pooled data analysis of CPR-associated cardiovascular, pulmonary, pleural, and thoracic wall injuries. DATA SOURCES PubMed, Scopus, EMBASE, and Web of Science were searched to identify relevant published studies. Unpublished studies were identified by searching the Australian and New Zealand Clinical Trials Registry, World Health Organization International Clinical Trials Registry Platform, Cochrane Library, ClinicalTrials.gov, Current Controlled Trials, and Google. STUDY SELECTION Inclusion criteria for the pooled analysis were any clinical or autopsy study in which a) patients underwent cardiopulmonary resuscitation, b) chest compressions were administered either manually or with the assistance of active compression-decompression devices, and c) autopsy or dedicated imaging assessments were conducted to identify complications. Exclusion criteria for the pooled analysis were pre-clinical studies, case reports and abstracts. DATA EXTRACTION Nine-hundred twenty-eight potentially relevant references were identified. Twenty-seven references met inclusion criteria. DATA SYNTHESIS A systematic review of the literature is provided with pooled data analysis. CONCLUSIONS The incidence of reported CPR-associated cardiovascular and thoracic wall injuries varies widely. CPR with active compression-decompression devices has a higher reported incidence of cardiopulmonary injuries. Bedside ultrasound may be a useful adjunct to assess and risk-stratify patients to identify serious or life-threatening CPR-associated injuries.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries

et al. 2014

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“…Post-arrest AKI is strongly related with worse neurological outcome and survival [2][3][4]. Besides, nearly 60% of survivors of CA are presented with intestinal injury [5], which has been proved via endoscopy and autopsy after CPR [5,6]. Due to the susceptibility to I/R, mesenteric ischemia often occurs, causing an increase in intestinal permeability and subsequent bacterial translocation [7], which may be exceedingly detrimental [8].…”

Section: Introductionmentioning

confidence: 99%

Fast Hypothermia Induced by Continuous Renal Replacement Therapy Alleviates Renal and Intestinal Injury after Cardiac Arrest in Swine

Shi

Wang³

et al. 2020

Preprint

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Background: Renal and intestinal damage lead to multiple organ dysfunction and death after cardiopulmonary resuscitation (CPR), and can be partly mitigated by therapeutic hypothermia. Currently, continuous renal replacement therapy (CRRT) was demonstrated to be an effective way to induce hypothermia. In the present study, we aimed to investigate the influence of CRRT cooling on renal and intestinal damage after CPR based on a porcine model.Methods: 32 swine were subjected to ventricular fibrillation for 8 min, while defibrillation was performed at 5 min of CPR. All pigs were randomly allocated to receive CRRT (n = 9), surface cooling (SC, n = 9), normothermia (NT, n = 9) or sham control (Control, n = 5) at 5 min post resuscitation. In the CRRT group, the pigs were cooled by the combination of 8-hr CRRT and 16-hr SC, a rate of 180 ml/min of blood flow was initially set with the infusion line submerged in 4 °C of ice water. In the SC group, pigs were cooled by the 24-hr SC. As to the NT and Control groups, the temperatures were maintained at a normal range. The levels of creatinine (Cr), blood urea nitrogen (BUN), intestinal fatty acid binding protein (IFABP) and diamine oxidase (DAO) in serum were measured at baseline and at 1, 3, 6, 12, 24 and 30h post resuscitation. Additionally, tissues of kidney and intestine were harvested, from which the levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), the contents of malondialdehyde (MDA), activities of superoxide dismutase (SOD) and the apoptosis levels were analyzed. Results: After resuscitation, the blood temperature decreased significantly more rapidly in the CRRT group than in the SC group (9.8 ± 1.6 vs. 1.5 ± 0.4 ℃/h, P < 0.01). The levels of Cr, BUN, IFABP and DAO after resuscitation were significantly lower in the two hypothermic groups compared with the NT group. Furthermore, from pathological evidence, cooling induced by CRRT alleviated post-resuscitation renal and intestinal injury compared to SC.Conclusion: Fast hypothermia induced by continuous renal replacement therapy was superior to surface cooling in mitigating renal and intestinal injury post resuscitation.

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Thrombolytic Therapy During Cardiopulmonary Resuscitation

Snyder-Ramos

Motsch²,

Martin³

et al.

En]Yearbook of Intensive Care and Emergency Medicine

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Unexpected findings and complications at autopsy after cardiopulmonary resuscitation (CPR)

Cited by 28 publications

References 0 publications

A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries

A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries

Fast Hypothermia Induced by Continuous Renal Replacement Therapy Alleviates Renal and Intestinal Injury after Cardiac Arrest in Swine

Thrombolytic Therapy During Cardiopulmonary Resuscitation

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