Kardiyopulmoner Resüsitasyon Sonrası Anatomik Yaralanmalar: Otopsi Olgularında Retrospektif Bir Değerlendirme

Yıl 2025, Cilt: 35 Sayı: 4, 736 - 745, 29.08.2025

Berna Doğan , Mert Nahir , Ahmet Depreli

https://doi.org/10.54005/geneltip.1700018

Öz

Öz
Amaç: Bu çalışmada, adli otopsi olgularında kardiyopulmoner resüsitasyon (CPR) uygulamasına bağlı sistem düzeyindeki anatomik yaralanmalar değerlendirilmiş ve bu yaralanmaların CPR süresi, yaş ve cinsiyet gibi değişkenlerle ilişkisi araştırılmıştır.
Gereç ve Yöntem: Şubat 2024 ile Mart 2025 tarihleri arasında travmatik olmayan nedenlerle yaşamını yitiren ve manuel CPR uygulanan toplam 121 olgu çalışmaya dâhil edilmiştir. Tüm olgularda iskelet sistemi (kaburga ve sternum kırıkları), kardiyak yapılar (epikardiyal, endokardiyal ve perikardiyal kanamalar), solunum sistemi, abdominal organlar (karaciğer, dalak, diyafram) ve büyük damarlar açısından yaralanmalar sistematik olarak değerlendirilmiştir.
Bulgular: Olguların %67,7’sinde kaburga, %57,8’inde sternum kırığı saptanmıştır. Sternum kırığı saptanan olguların %93,3’ünde eş zamanlı kaburga kırığı da mevcuttur. Kaburga kırıkları sıklıkla bilateral yerleşimli olup, en sık 3. ile 6. kostalar arasında; özellikle bilateral 6. kostada yoğunlaşmıştır. Kardiyak yapılar arasında epikardiyumda (%43,8), endokardiyumda (%39,7) ve perikardda (%45,5) hemorajik bulgular izlenmiştir. Abdominal organlardaki yaralanmalar karaciğer (%37,2), dalak (%27,3) ve diyafram (%39,7) düzeyinde tespit edilmiştir. CPR süresi ile kardiyak ve visseral organ hasarlarının şiddeti arasında istatistiksel olarak anlamlı pozitif korelasyon saptanmıştır (p<0.001).
Sonuç: CPR, yalnızca iskelet sistemiyle sınırlı kalmayıp, çoklu organ sistemlerinde ciddi travmatik komplikasyonlara yol açabilir. Özellikle uzun süreli resüsitasyon girişimlerinde visseral yapılar belirgin şekilde etkilenmektedir. Otopsi temelli değerlendirmeler, bu tür yaralanmaların belirlenmesinde kapsamlı ve güvenilir bir yaklaşım sunar. Bulgular, CPR’ye bağlı komplikasyonların hem adli hem de klinik açıdan bütüncül bir bakış açısıyla değerlendirilmesinin önemini ortaya koymaktadır.

Anahtar Kelimeler

otopsi , CPR , kaburga kırığı , sternum kırığı , visseral organ hasarı

Anatomical Injuries Following Cardiopulmonary Resuscitation: A Retrospective Evaluation in Autopsy Cases

Öz

Abstract
Background/Aims: This study aimed to evaluate the anatomical injuries resulting from cardiopulmonary resuscitation (CPR) at the system level in forensic autopsy cases and to investigate their association with variables such as CPR duration, age, and sex.
Methods: A total of 121 cases, who underwent manual CPR and died from non-traumatic causes between February 2024 and March 2025, were included in the study. In all cases, injuries were systematically assessed across the skeletal system (rib and sternum fractures), cardiac structures (epicardial, endocardial, and pericardial hemorrhages), respiratory system, abdominal organs (liver, spleen, diaphragm), and major vessels.
Results: Rib fractures were detected in 67.7% of the cases and sternum fractures in 57.8%. Among those with sternum fractures, 93.3% also had concurrent rib fractures. Rib fractures were frequently bilateral, most commonly observed between the 3rd and 6th ribs, with a notable concentration at the bilateral 6th rib. Hemorrhages were identified in the epicardium (43.8%), endocardium (39.7%), and pericardium (45.5%) among cardiac structures. Injuries in the abdominal organs included the liver (37.2%), spleen (27.3%), and diaphragm (39.7%). A statistically significant positive correlation was found between CPR duration and the severity of cardiac and visceral injuries (p<0.001).
Conclusion: CPR can lead to severe traumatic complications not only in the skeletal system but also in multiple organ systems. Particularly in prolonged resuscitation efforts, visceral structures appear to be substantially affected. Autopsy-based evaluations offer a comprehensive and reliable approach to identifying such injuries. The findings highlight the importance of assessing CPR-related complications from both forensic and clinical perspectives using a more holistic approach.

Anahtar Kelimeler

autopsy , CPR , rib fracture , sternum fracture , visceral organ injury

Teşekkür

We would like to thank the Tokat Council of Forensic for their support in providing access to the autopsy data used in this study.

Kaynakça

• 1. Hashimoto Y, Moriya F, Furumiya J. Forensic aspects of complications resulting from cardiopulmonary resuscitation. Leg Med (Tokyo). 2007;9(2):94-9.
• 2. Ihnát Rudinská L, Hejna P, Ihnát P, Tomášková H, Smatanová M, Dvořáček I. Intra-thoracic injuries associated with cardiopulmonary resuscitation - Frequent and serious. Resuscitation. 2016;103:66-70.
• 3. Righi FA, Jenkins S, Lin PT. Nonskeletal injuries related to cardiopulmonary resuscitation: An autopsy study. J Forensic Sci. 2021;66(6):2299-306.
• 4. Girotti P, Rizzuto A, Orsini V, Hodja V, Koenigsrainer I. Heart injuries related to cardiopulmonary resuscitation: a risk often overlooked. Rev Cardiovasc Med. 2022;23(2):61.
• 5. Smekal D, Hansen T, Sandler H, Rubertsson S. Comparison of computed tomography and autopsy in detection of injuries after unsuccessful cardiopulmonary resuscitation. Resuscitation. 2013;84(3):357-60.
• 6. Baubin M, Sumann G, Rabl W, Eibl G, Wenzel V, Mair P. Increased frequency of thorax injuries with ACD-CPR. Resuscitation. 1999;41(1):33-8.
• 7. Black CJ, Busuttil A, Robertson C. Chest wall injuries following cardiopulmonary resuscitation. Resuscitation. 2004;63(3):339-43.
• 8. Boz B, Erdur B, Acar K, Ergin A, Türkçüer İ, Ergin N. Frequency of skeletal chest injuries associated with cardiopulmonary resuscitation: forensic autopsy. Ulus Travma Acil Cerrahi Derg. 2008;14(3):216-20.
• 9. Hoke RS, Chamberlain D. Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation. 2004;63(3):327-38.
• 10. Lederer W, Mair D, Rabl W, Baubin M. Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray. Resuscitation. 2004;60(2):157-62.
• 11. Deliliga A, Chatzinikolaou F, Koutsoukis D, Chrysovergis I, Voultsos P. Cardiopulmonary resuscitation (CPR) complications encountered in forensic autopsy cases. BMC Emerg Med. 2019;19(1):23.
• 12. Rabl W, Baubin M, Broinger G, Scheithauer R. Serious complications from active compression-decompression cardiopulmonary resuscitation. Int J Legal Med. 1996;109(2):84-9.
• 13. Krischer JP, Fine EG, Davis JH, Nagel EL. Complications of cardiac resuscitation. Chest. 1987;92(2):287-91.
• 14. Kralj E, Podbregar M, Kejžar N, Balažic J. Frequency and number of resuscitation-related rib and sternum fractures are higher than generally considered. Resuscitation. 2015;93:136-41.
• 15. Azeli Y, Barbería E, Jiménez-Herrera M, Ameijide A, Axelsson C, Bardaj A. Serious injuries secondary to cardiopulmonary resuscitation: incidence and associated factors. Emergencias. 2019;31(5):327-34.
• 16. Yamaguchi R, Makino Y, Chiba F, Torimitsu S, Yajima D, Inokuchi G, et al. Frequency and influencing factors of cardiopulmonary resuscitation-related injuries during implementation of the American Heart Association 2010 Guidelines: a retrospective study based on autopsy and postmortem computed tomography. Int J Legal Med. 2017;131(6):1655-63.
• 17. Añon J, Remonda L, Spreng A, Scheurer E, Schroth G, Boesch C, et al. Traumatic extra-axial hemorrhage: correlation of postmortem MSCT, MRI, and forensic-pathological findings. J Magn Reson Imaging. 2008;28(4):823-36.
• 18. Renfrew DL, Franken EA, Jr., Berbaum KS, Weigelt FH, Abu-Yousef MM. Error in radiology: classification and lessons in 182 cases presented at a problem case conference. Radiology. 1992;183(1):145-50.
• 19. Hamanaka K, Nishiyama K, Nakamura M, Takaso M, Hitosugi M. Both Autopsy and Computed Tomography Are Necessary for Accurately Detecting Rib Fractures Due to Cardiopulmonary Resuscitation. Diagnostics. 2020;10(9):697.
• 20. Oberladstaetter D, Braun P, Freund MC, Rabl W, Paal P, Baubin M. Autopsy is more sensitive than computed tomography in detection of LUCAS-CPR related non-dislocated chest fractures. Resuscitation. 2012;83(3):e89-90.