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Correlation of pulmonary fat embolism with trauma and resuscitation in children

Rosa Maria Martinez1, Wolf Schweitzer2, Michael Josef Thali2

  • 1Repubblica e Cantone Ticino, Institute of Forensic Medicine, Bellinzona, Switzerland.

International Journal of Legal Medicine
|May 23, 2025
PubMed

Insights

Pulmonary fat embolism (PFE) in children is linked to trauma and resuscitation, especially with intraosseous catheters. Fat tissue crushing, not just fractures, can cause PFE.

Area of Science:

  • Forensic Medicine
  • Pediatric Pathology
  • Trauma Research

Background:

  • Pulmonary fat embolism (PFE) is a potential complication in pediatric fatalities.
  • Understanding PFE's correlation with trauma and resuscitation is crucial for forensic analysis.

Purpose of the Study:

  • To investigate the relationship between pulmonary fat embolism (PFE), blunt force trauma, and resuscitation effects in pediatric deaths.
  • To determine factors influencing PFE development in children.

Main Methods:

  • Autopsy data from 57 children (0-10 years) between 2019-2023.
  • Analysis of trauma, fractures, fat crushing extent, and cardiopulmonary resuscitation (CPR) methods (including intraosseous catheter use).
  • Grading of PFE using the Falzi et al. scale.

Main Results:

  • PFE was more frequent in cases with both trauma and resuscitation, particularly with intraosseous catheter use.
  • Fat tissue crushing and fracture extent correlated with PFE development.
  • PFE can occur without fractures, linked to fat crushing; CPR alone showed no strong correlation.

Conclusions:

  • Pulmonary fat embolism in children can result from fat tissue crushing alone, even without fractures.
  • Intraosseous catheter CPR correlated with moderate PFE (Falzi grade 2), but CPR alone was not a strong predictor.
Abstract

Keywords:
Blunt traumaCPRForensicPediatricPulmonary fat embolismResuscitation

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