Injuries Resulting From Resuscitation Procedures

Summary

Life-threatening situations deserve fast medical intervention but resuscitation procedures may have considerable effects on the patient’s health condition because (additional) trauma may occur. Additionally, these accidentally caused iatrogenic injuries might by themselves be life-threatening for the patient. The main injurious resuscitation measures include standard cardiopulmonary resuscitation (Std-CPR), active compression-decompression cardiopulmonary resuscitation (ACD-CPR), defibrillation, tracheotomy, coniotomy, tracheal intubation, puncture of veins or pericardium, and decompression of tension pneumothorax or mediastinal emphysema. In particular, injuries as a result of CPR are commonly encountered at autopsy and often not unexpected for the forensic pathologist. The most common cardiac resuscitation-related injuries are fractures of the ribs and sternum in 40-70% of cases. Above all, elderly patients are prone to such injuries. Trauma related to CPR is a rare complication in children. When encountering pediatric rib fractures, the forensic pathologist has to be aware of the differential diagnosis of child abuse since rib fractures, especially when of different ages and affecting multiple adjacent ribs, are a hallmark of nonaccidental injury in children. CPR may lead to severe injuries of internal organs. Main factors influencing frequency and severity of injuries resulting from resuscitation procedures include length of resuscitation time, age of the patient, and degree of qualification of the medical personnel. From the medicolegal point of view, complications and accidental iatrogenic injuries will never be completely avoidable but their possibility has to be taken into consideration throughout further medical treatment. An undetected injury may result in impairment or even death of the patient and the responsible physician runs the risk of being prosecuted. To give a correct opinion, especially in cases of questioned medical malpractice, it is essential that forensic medical experts are familiar with resuscitation-related injuries and are able to distinguish them from the sequels of a natural disease process or trauma that occurred prior to resuscitation procedures.