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Cardiopulmonary Resuscitation and Direct Cardiac Injury: Evidence of Fractured Coronary Arteries and HIS Bundle
Insights
Cardiopulmonary resuscitation (CPR) can cause direct blunt injury to coronary arteries and the His Bundle. This study found these injuries in 44% of patients who received CPR, with higher frequency in females.
Area of Science:
- Cardiology
- Pathology
- Emergency Medicine
Background:
- Closed-chest cardiopulmonary resuscitation (CPR) is assumed to avoid direct cardiac injury.
- Histologic studies on CPR-induced injury to coronary arteries and the atrioventricular conduction system are lacking.
Purpose of the Study:
- To investigate potential histologic evidence of direct blunt injury to coronary arteries and the His Bundle from CPR.
- To determine the frequency and characteristics of such injuries.
Main Methods:
- Retrospective autopsy study of 105 human hearts.
- Coronary arteries were injected with a colored barium gelatin mass.
- Histologic examination focused on coronary arteries and the His Bundle region.
Main Results:
- Direct blunt injury to coronary arteries and/or the His Bundle was observed in 35 (44%) of patients who received CPR.
- Injuries included coronary artery wall fracture/disruption and hemorrhage in the His Bundle region.
- Females showed a significantly higher frequency of these lesions and were older than males.
Conclusions:
- Cardiopulmonary resuscitation (CPR) is associated with direct blunt injury to coronary arteries and the His Bundle.
- These CPR-induced lesions may impact resuscitation outcomes and long-term prognosis.
Abstract:
The heart is believed to escape serious direct injury during the administration of closed chest cardiopulmonary resuscitation (CPR). However, no comprehensive histologic studies of the coronary arteries or the atrioventricular conduction system have been performed to determine whether these structures might be injured by CPR. This report includes a retrospective review of 105 human hearts extensively studied at autopsy after the injection of a colored barium gelatin mass into the coronary arteries. The study group, 83 males and 22 females, included 63 patients (60%) who died in the hospital. Eighty patients (76%) received CPR immediately prior to death. Evidence consistent with direct blunt injury to the coronary arteries and/or the His Bundle was found in 35 (44%) patients who received CPR. These structural changes were characterized by fracture and disruption of the coronary artery wall and/or hemorrhage into the region of the branching His Bundle. Females were significantly older and showed a significantly higher frequency of these lesions than males. Injuries were not related to the site where CPR was administered, in- or out-of-hospital, nor to the duration of CPR. We conclude that CPR is associated with evidence of direct blunt injury to the coronary arteries and/or the His Bundle and proximal bundle branches; and that these lesions may influence the outcome of resuscitative efforts as well as ultimate prognosis.