Forensic autopsy-confirmed COVID-19-induced out-of-hospital cardiac arrest

Area of Science:

• Forensic pathology
• Infectious disease pathology
• Pulmonary pathology

Background:

• Limited autopsy data exists for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) deaths outside hospitals during lockdown.
• This study presents the first forensic autopsy series of coronavirus disease 2019 (COVID-19)-related out-of-hospital cardiac arrest (OHCA).

Purpose of the Study:

• To investigate the causes of death in COVID-19 patients experiencing out-of-hospital cardiac arrest.
• To analyze the autopsy findings in relation to SARS-CoV-2 infection and its pulmonary manifestations.

Main Methods:

• Four cases of COVID-19-related OHCA were subjected to forensic autopsy between March and April 2020.
• Autopsies followed recommended safety procedures, including gross and microscopic examination of organs, particularly the lungs.

Main Results:

• Autopsies of four individuals (3 male/1 female, mean age 56.8 years) presenting with symptomatic COVID-19 were performed.
• Three cases showed natural death due to acute respiratory failure caused by SARS-CoV-2, characterized by edematous lungs, peripheral thrombi, and diffuse alveolar damage (DAD).
• One case was determined to be violent death due to suicidal alcohol intoxication during COVID-19 lockdown; no cardiac lesions were observed.

Conclusions:

• Out-of-hospital cardiac arrests in these COVID-19 cases were primarily attributed to non-cardiac causes directly linked to SARS-CoV-2-induced diffuse alveolar damage.
• Forensic autopsies remain valuable for understanding the pathological processes of emerging infectious diseases like COVID-19, offering both medical and legal insights.