Complications of cardiopulmonary resuscitation

Aim. In 1960, Kouwenhoven observed that forceful chest compressions can produce arterial pulses. At following years cardiopulmonary resuscitation (CPR) continually advanced. Right now experts at the International Guidelines 2000 Conference strongly recommended development of inschool CPR programs as a primary educational strategy to ensure wide-spread learning of CPR. Rib and sternum fractures are frequent complications of CPR in adults. Fractures frequently occur at ribs, number 3-8 and between parasternal and axillary line; can be seen at the both sides but tends to be seen at the left side of the thorax. Fractures of rib 1 and 8-12 were very rare. Because of pliability of the ribs and costal cartilages, chest wall fractures are rare in children. This study was conducted to determine the incidence and effects of the complications of CPR. Method. The forensic records of 26912 deaths referred to Council of Forensic Medicine for autopsy in 1993– 2002 were reviewed. Cases were included for analysis where the forensic case notes indicated there had been attempts at CPR, and no historical or physical evidence that trauma was the cause of death. We studied of autopsy findings on 602 eligible deaths that died after an attempt at CPR and without any other trauma. Results. Sternal and/or rib fracture stated in 97 (%16.1) of 602 cases. 433 (%71.9) of the 602 cases were male, and 169 (%28.1) female. Sixty-nine percent of the rib fractures were at the left side of the thorax. Seventy-one percent of these left sided fractures were found at the midclavicular line, 14% at the parasternal and 12% were found at the axillary line. In our study fractures were found frequently on the left 3.-4.-5. ribs at the midclavicular line. Sternal fractures were found in 29 (4.8%) of the cases. Liver injury was found in 4 (0.7%) cases. Conclusion. If CPR complications are not known sufficiently it may cause various problems, for both clinical and postmortem investigations. We have to know that CPR complications, can cause death itself, or it can be misinterpreted to be blunt trauma as a cause of death, and also we should keep in mind that it can be evaluated as medical malpractice.