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Massive injury to the heart after attempted active compression-decompression cardiopulmonary resuscitation
M Klintschar1, M Darok, H Radner
1Institute of Legal Medicine, University of Graz, Austria.
Insights
Extensive cardiac injuries, including ventricular and atrial rupture, occurred during cardiopulmonary resuscitation (CPR) with an active compression-decompression (ACD) device. This case highlights potential risks associated with ACD devices, especially in elderly patients with pre-existing conditions.
Area of Science:
- Cardiology
- Emergency Medicine
- Forensic Pathology
Background:
- Cardiopulmonary resuscitation (CPR) is a critical intervention for cardiac arrest.
- Active compression-decompression (ACD) devices are used to augment CPR efforts.
- Potential complications of CPR, including chest trauma, are well-documented.
Observation:
- An 84-year-old female experienced cardiac arrest and underwent CPR, including 15 minutes of ACD.
- Autopsy revealed extensive cardiac injuries: myocardial infarction, rupture of the infarcted area, pericardial tamponade, rib fractures, sternal fracture, pericardial sac rupture, and lacerations of the ascending aorta.
- No signs of vital reaction were noted at the injury sites.
Findings:
- The patient's death was attributed to myocardial infarction complicated by rupture and pericardial tamponade.
- The observed cardiac injuries were unusually extensive and not previously reported following CPR.
- Contributing factors may include pre-existing pericardial tamponade, advanced age, and incorrect placement of the ACD device.
Implications:
- This case raises concerns about the potential for severe cardiac injury with ACD device use during CPR.
- It suggests an increased risk of cardiac trauma when using ACD devices, particularly in elderly patients or those with cardiac comorbidities.
- Further investigation into the safety profile and optimal application of ACD devices is warranted.
Abstract:
An 84-year-old woman was unsuccessfully resuscitated for 3 min using standard cardiopulmonary resuscitation (CPR), followed by 15 min of active compression-decompression (ACD). The autopsy revealed that death was due to myocardial infarction complicated by rupture of the infarcted area and pericardial tamponade was diagnosed. Furthermore, a series of rib fractures, a transverse fracture of the sternum, rupture of the pericardial sac, the right ventricle, both atria and lacerations of the ascending aorta, were found with no signs of a vital reaction. To our knowledge, such extensive cardiac injury after CPR has not been previously reported. It is suggested that the pre-existing pericardial tamponade, the age of the patient and the application of the ACD-device to incorrect areas of the chest contributed to the extent of the cardiac injury. This case further adds to the suspicion of an increased risk of cardiac injuries when using an ACD device for cardiac massage.