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Intensive Care Medicine

, Volume 35, Issue 3, pp 397–404 | Cite as

Frequent and rare complications of resuscitation attempts

  • Claas T. Buschmann
  • Michael Tsokos
Review

Abstract

Introduction

Resuscitation attempts require invasive iatrogenic manipulations on the patient. On the one hand, these measures are essential for survival, but on the other hand can damage the patient and thus contain a significant violation risk of both medical and forensic relevance for the patient and the physician. We differentiate between frequent and rare resuscitation-related injuries. Factors of influence are duration and intensity of the resuscitation attempts, sex and age of the patient as well as an anticoagulant medication.

Materials and methods

Review of current literature and report on autopsy cases from our institute (approximately 1,000 autopsies per year).

Results

Frequent findings are lesions of tracheal structures and bony chest fractures. Rare injuries are lesions of pleura, pericardium, myocardium and other internal organs as well as vessels, intubation-related damages of neural and cartilaginous structures in the larynx and perforations of abdominal organs such as liver, stomach and spleen.

Conclusion

We differentiate between frequent and rare complications. The risk of iatrogenic CPR-related trauma is even present with adequate execution of CPR measures and should not question the employment of proven medical techniques.

Keywords

Resuscitation-related injuries Frequencies Medical relevance Forensic relevance 

Notes

Acknowledgments

This work was supported by the State Institute of Legal and Social Medicine, Berlin/Germany (Director: Prof. M. Tsokos, MD).

References

  1. 1.
    Alconero Camarero AR, Casaus Pérez M, Gutiérrez Caloca N (2006) Incidents of cutaneous alteration secondary to external electrical cardioversion. Enferm Intensiva 17:163–172PubMedCrossRefGoogle Scholar
  2. 2.
    Bauer H, Welsch K (1976) Punktions-Techniken in der Notfallmedizin. Münchener Medizinische Wochenschrift 118:567–572PubMedGoogle Scholar
  3. 3.
    Betz P, Liebhardt E (1994) Rib fractures in children—resuscitation or child abuse? Int J Legal Med 106:215–218PubMedCrossRefGoogle Scholar
  4. 4.
    Bode G, Joachim H (1987) Zur Differentialdiagnose von Unfall- und Reanimationstraumen. Z Rechtsmed 98:19–32PubMedCrossRefGoogle Scholar
  5. 5.
    Darok M (2004) Injuries resulting from resuscitation procedures. In: Tsokos M (ed) Forensic pathology reviews Vol 1. Humana Press Inc, Totowa NJ, pp 293–303Google Scholar
  6. 6.
    Eldor J, Ofek B, Abramowitz HB (1990) Perforation of oesophagus by tracheal tube during resuscitation. Anaesthesia 45:70–71PubMedCrossRefGoogle Scholar
  7. 7.
    Hartoko TJ, Demey HE, Rogers PE, Decoster HL, Nagler JM, Bossaert LL (1991) Pneumoperitoneum—a rare complication of cardiopulmonary resuscitation. Acta Anaesth Scand 35:235–237PubMedCrossRefGoogle Scholar
  8. 8.
    Hashimoto Y, Moriya F, Furumiya J (2007) Forensic aspects of complications resulting from cardiopulmonary resuscitation. Leg Med 9:94–99CrossRefGoogle Scholar
  9. 9.
    Hoke RS, Chamberlain D (2004) Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation 63:327–338PubMedCrossRefGoogle Scholar
  10. 10.
    Jaeger K, Ruschulte H, Osthaus A, Scheinichen S, Heine J (2000) Tracheal injury as a sequence of multiple attempts of endotracheal intubation in the course of a preclinical cardiopulmonary resuscitation. Resuscitation 43:147–150PubMedCrossRefGoogle Scholar
  11. 11.
    Kardiopulmonale Reanimation—Aktuelle Leitlinien des European Resuscitation Council (2006) Notfall- und Rettungsmedizin 9:4–170Google Scholar
  12. 12.
    Klintschar M, Darok M, Radner H (1998) Massive injury to the heart after attempted active compression–decompression cardiopulmonary resuscitation. Int J Legal Med 111:93–96PubMedCrossRefGoogle Scholar
  13. 13.
    Kurkciyan I, Meron G, Sterz F, Müllner M, Tobler K, Domanovits H, Schreiber W, Bankl HC, Laggner AN (2003) Major bleeding complications after cardiopulmonary resuscitation: impact of thrombolytic treatment. J Int Med 253:128–135CrossRefGoogle Scholar
  14. 14.
    Krause S, Donen N (1984) Gastric rupture during cardiopulmonary resuscitation. Can Anaesth Soc J 31:319–322PubMedCrossRefGoogle Scholar
  15. 15.
    Krischer JP, Fine EG, Davis JH, Nagel EL (1987) Complications of cardiac resuscitation. Chest 92:287–291PubMedCrossRefGoogle Scholar
  16. 16.
    Larsen R (2002) Kardiopulmonale Reanimation. In: Larsen R (ed) Anästhesie, 8th edn. Urban and Fischer Publishing House, München Jena, pp 851–900Google Scholar
  17. 17.
    Lawes EG, Baskett PJ (1987) Pulmonary aspiration during unsuccessful cardiopulmonary resuscitation. Intensive Care Med 13:379–382PubMedCrossRefGoogle Scholar
  18. 18.
    Lederer W, Mair D, Rabl W, Baubin M (2004) Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray. Resuscitation 60:157–162PubMedCrossRefGoogle Scholar
  19. 19.
    Maxeiner H (1988) Weichteilverletzungen am Kehlkopf bei notfallmäßiger Intubation. Anästh Intensivmed 29:42–49Google Scholar
  20. 20.
    Meron G, Kurkciyan I, Sterz F, Susani M, Domanovits H, Tobler K, Bohdjalian A, Laggner AN (2007) Cardiopulmonary resuscitation-associated major liver injury. Resuscitation. doi: 10.1016/j.resuscitation.2007.05.023
  21. 21.
    Mills SA, Paulson D, Scott SM, Sethi G (1983) Tension pneumoperitoneum and gastric rupture following cardiopulmonary resuscitation. Ann Emerg Med 12:94–95PubMedCrossRefGoogle Scholar
  22. 22.
    Minor RL Jr, Chandran PK, Williams CL (1990) Rhabdomyolysis and myoglobinuric renal failure following cardioversion and CPR for acute MI. Chest 97:485–486PubMedCrossRefGoogle Scholar
  23. 23.
    Noffsinger AE, Blisard KS, Balko MG (1991) Cardiac laceration and pericardial tamponade due to cardiopulmonary resuscitation after myocardial infarction. J Forensic Sci 36:1760–1764PubMedGoogle Scholar
  24. 24.
    Odom A, Christ E, Kerr N, Byrd K, Cochran J, Barr F, Bugnitz M, Ring JC, Storgion S, Walling R, Stidham G, Quasney MW (1997) Prevalence of retinal hemorrhages in pediatric patients after in-hospital cardiopulmonary resuscitation: a prospective study. Pediatrics. doi: 10.1542/peds.99.6.e3
  25. 25.
    Price EA, Rush LR, Perper JA, Bell MD (2000) Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children. Am J Forensic Med Pathol 21:307–310PubMedCrossRefGoogle Scholar
  26. 26.
    Rabl W, Baubin M, Haid C, Pfeiffer KP R, Scheithauer R (1997) Review of active compression–decompression cardiopulmonary resuscitation (ACD-CPR). Analysis of iatrogenic complications and their biomechanical explanation. Forensic Sci Int 89:175–183PubMedCrossRefGoogle Scholar
  27. 27.
    Reichardt JA, Casey GD, Krywko D (2008) Gastric rupture from cardiopulmonary resuscitation or seizure activity? a case report. J Emerg Med. doi: 10.1016/j.jemermed.2007.10.041
  28. 28.
    Ryan MP, Young SJ, Wells DL (2003) Do resuscitation attempts in children who die, cause injury? Emerg Med J 20:10–12PubMedCrossRefGoogle Scholar
  29. 29.
    Saternus KS, Fuchs V (1982) Verletzungen der A. carotis communis durch Reanimationsmaßnahmen. Z Rechtsmed 88:305–311Google Scholar
  30. 30.
    Schvadron E, Moses Y, Weissberg D (1996) Gastric rupture complicating inadvertent intubation of the esophagus. Can J Surg 39:487–489PubMedGoogle Scholar
  31. 31.
    Shulman D, Beilin B, Olshwang D (1987) Pulmonary barotrauma during cardiopulmonary resuscitation. Resuscitation 15:201–207PubMedCrossRefGoogle Scholar
  32. 32.
    Sokolove PE, Willis-Shore J, Panacek EA (2002) Exsanguination due to right ventricular rupture during closed-chest cardiopulmonary resuscitation. J Emerg Med 23:161–164PubMedCrossRefGoogle Scholar
  33. 33.
    Sperry K (1990) Anterior thoracic wall trauma in elderly homicide victims. The “CPR” defense. Am J Forensic Med Pathol 11:50–55PubMedCrossRefGoogle Scholar
  34. 34.
    Strear CM, Jarnagin WR, Schecter W, Mackersie RC, Hickey MS (1998) Gastric rupture and tension pneumoperitoneum complicating cardiopulmonary resuscitation: case report. J Trauma 44:930–932PubMedCrossRefGoogle Scholar
  35. 35.
    Umach P, Unterdorfer H (1980) Organverletzungen durch Reanimationsmaßnahmen. Beiträge zur Gerichtlichen Medizin 38:29–32PubMedGoogle Scholar
  36. 36.
    Valenzuela TD, Kern KB, Clark LL, Berg RA, Berg MD, Berg DD, Hilwig RW, Otto CW, Newburn D, Ewy GA (2005) Interruptions of chest compressions during emergency medical systems resuscitation. Circulation 112:1259–1265PubMedCrossRefGoogle Scholar
  37. 37.
    van der Voort DJ, Geusens PP, Dinant GJ (2001) Risk factors for osteoporosis related to their outcome: fractures. Osteoporos Int 12:630–638PubMedCrossRefGoogle Scholar
  38. 38.
    Wik L, Kramer-Johansen J, Myklebust H, Sørebø H, Svensson L, Fellows B, Steen PA (2005) Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 293:299–304PubMedCrossRefGoogle Scholar
  39. 39.
    Yamaki T, Ando S, Ohta K, Kubota T, Kawasaki K, Hirama M (1989) CT demonstration of massive cerebral air embolism from pulmonary barotraumas due to cardiopulmonary resuscitation. J Comput Assist Tomogr 13:313–315PubMedCrossRefGoogle Scholar
  40. 40.
    Ziegenfuss MD, Mullany DV (2004) Traumatic liver injury complicating cardio-pulmonary resuscitation. The value of a major intensive care facility: a report of two cases. Crit Care Resusc 2:102–104Google Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.University Medical Centre Charité, University of Berlin, Institute of Legal Medicine and Forensic SciencesBerlinGermany

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