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Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation

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Abstract

Iatrogenic consequences of cardiopulmonary resuscitation (CPR) include sternal or rib fractures, pulmonary bone marrow embolisms (BME) and fat embolisms (FE). This report aimed to analyze the frequency and intensity of pulmonary BME and FE in fatal cases receiving final CPR efforts with the use of automated chest compression devices (ACCD) or manual chest compressions (mCC). The study cohort (all cardiac causes of death, no ante-mortem fractures) consisted of 15 cases for each group ‘ACCD’, ‘mCC’ and ‘no CPR’. Lung tissue samples were retrieved and stained with hematoxylin eosin (n = 4 each) and Sudan III (n = 2 each). Evaluation was conducted microscopically for any existence of BME or FE, the frequency of BME-positive vessels, vessel size for BME and the graduation according to Falzi for FE. The data were compared statistically using non-parametric analyses. All groups were matched except for CPR duration (ACCD > mCC) but this time interval was linked to the existence of pulmonary BME (p = 0.031). Both entities occur in less than 25% of all cases following unsuccessful CPR. BME was only detectable in CPR cases, but was similar between ACCD and mCC cases for BME frequency (p = 0.666), BME intensity (p = 0.857) and the size of BME-affected pulmonary vessels (p = 0.075). If any, only mild pulmonary FE (grade I) was diagnosed without differences in the CPR method (p = 0.624). There was a significant correlation between existence of BME and FE (p = 0.043). Given the frequency, intensity and size of pulmonary BME and FE following CPR, these conditions may unlikely be considered as causative for death in case of initial survival but can be found in lower frequencies in autopsy histology.

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Acknowledgements

The authors would like to thank Miss Cornelia Pietschmann for her skillful help in the histology laboratory and Miss Aqeeda Singh for proofreading the paper as a native speaker.

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Authors and Affiliations

  1. Institute of Legal Medicine, University of Leipzig, Johannisallee 28, D-04103, Leipzig, Germany

    Benjamin Ondruschka, Christina Baier, Jan Dreßler & Julia Schlote

  2. University Hospital, Emergency Department, Heinrich Heine University, Duesseldorf, Germany

    Michael Bernhard

  3. Institute of Legal Medicine, Charité–Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

    Claas Buschmann

  4. Department of Anatomy, University of Otago, Dunedin, New Zealand

    Johann Zwirner & Niels Hammer

  5. Department of Orthopedic and Trauma Surgery, University Hospital of Leipzig, Leipzig, Germany

    Niels Hammer

  6. Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany

    Niels Hammer

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  1. Benjamin Ondruschka
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Correspondence to Benjamin Ondruschka.

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The authors declare that they have no conflict of interest related to the given study.

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The study was approved by the ethics committee of the Medical Faculty of the University of Leipzig, Germany (code: 104/17-ek).

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Informed consent was waived due to the retrospective nature of the study.

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Ondruschka, B., Baier, C., Bernhard, M. et al. Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation. Forensic Sci Med Pathol 15, 48–55 (2019). https://doi.org/10.1007/s12024-018-0044-1

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