Forensic Aspects of Mecanicel Injuries Associated with Cardiopulmonary Resuscitation

Medical procedure performed during cardio-pulmonary resuscitation in some case can lead to the formation of somebody injuries. Spectrum of such injuries can vary – from simple to serious injuries which can neglect possibility of successful resuscitation and even cause death. In the article described various forms of injuries caused by closed-chest cardiac massage according to current literature. The most common injuries are chest wall fractures. Among them frequency of rib fractures where found during autopsy vary from 17 to 75 percent according to different studies; sternum fractures from single cases to 26 percent. In the most cases rib fractures had a bilateral involvement; from the one-side fractures predominantly left ribs injuries were described. Right ribs injuries were observed in single cases. Usually rib fractures were involved from third to seven ribs on the medial clavicular lines. In single cases were described fractures of other bones, like clavicle, spine etc. Weakened bone structures due to diseases, adult age, and prolonged closed-chest massage increase the possibility of chest wall fractures. Relation between fractures localization and hand placement during cardio-pulmonary resuscitation were described. Usually forensic diagnosis of such injuries easy for pathologist because of typical localization and morphology of resuscitation chest wall fractures. Nonetheless in some cases (effective cardiac output during cardiopulmonary resuscitation) injuries of chest wall bones can be accompanied with massive hemorrhage in soft tissue and cellular reaction. This can lead to the some problem in diagnosis of mechanism and role of such fractures. Precise analysis of medical documentation, circumstances of death is needed in such cases. Sometimes visceral injuries after closed-chest cardiac massage were found during autopsy. Among them heart and lung injuries, splenic and liver trauma, gastric and esophagus lacerations were described. Heart and lungs injuries pretty rare but very dangerous complication of cardio-pulmonary resuscitation. Such injuries usually lead to unsuccessful resuscitation. Injuries of thoracic organs in most cases accompanied with rib fractures. Abdominal injuries are more frequent. Among them are spleen, Liver and gastric laceration. Compression of lower chest and abdomen are probably lead to such kind of injuries. In gastric laceration also air overflow of stomach due to the forceful ventilation can have some value. Such, spectrum of resuscitation injuries can be very wide. Forensic pathologist must be aware in the assessment of such type of trauma. Sometimes difficulties in estimation of mechanism of injuries, caused by closed-chest cardiac massage can lead to some mistakes, for example wrong assessment such injuries as criminal blunt trauma and so on.