Slides from presentation on: Iatrogenic Changes Related to Peri-mortem CPR as documented by Post-mortem CT Scanning

1. Iatrogenic Changes Related to Peri-
mortem Cardiopulmonary
Resuscitation (CPR) as Documented by
Post-mortem Computed Tomography
(CT) Scanning
Aneesa Baig MSc, Curtis E Offiah MD, Nikolas P Lemos PhD
Cameron Forensic Medical Sciences | William Harvey Research Institute
Barts and The London School of Medicine and Dentistry, Queen Mary University of London
cameron-forensics@qmul.ac.uk

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American Heart Association, u.d.
Is CPR a “life-saving” procedure?

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Willaume et. al, 2018
Power of Forensic Post-mortem Radiology
• Adjunct to traditional autopsy
• Recognised up to 90% of injuries in a
total of 500 bodies, 29% more than
autopsy
• Minimally invasive with high sensitivity

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Hamananka et. al, 2020
1. Skeletal Complications
The most common form of injury: Rib and Sternal Fractures
(up to 70% of cases)
Offiah, 2021

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2. Cardiovascular Complications
• CPR-associated cardiovascular
injury in non-hospital and hospital
setting between 32-45%
• Pericardial injury due to
compressions – hemopericardium
(3-band pattern effect)
• ‘Cardiovascular gas’
• Ruptured aortic aneurysm Watanabe et. al, 2015
(A) Single band (B) Double band (C) Horizontal

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Offiah and Dean, 2015 Filograna et. al, 2015

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3. Respiratory Complications
• Secondary to rib fractures
• Lung contusions
• Compression-associated
pulmonary oedema vs post-
mortem hypostasis?
• Endotracheal (ET) intubation
• 3D-reconstructive PMCT
Kaewlai, Avery, Asrani and Novelline, 2008

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Aghayev et. al, 2005
Cho et. al, 2013

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Camden and Carucci, 2011
Arai et. al, 2017
4. Gastrointestinal and Intra-peritoneal Injury
• Traumatic gastric
perforation
• Mal-positioned ET tubes
• Hepatic portal venous
gas
• Automated CPR devices

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Hwang et. al, 2004
5. Nervous System (Brain and Spinal Cord) Injury
• Intracerebral air emboli
• Hypoxic-ischaemic brain
injury
• Intracranial penetration of
nasopharyngeal tubes
• Spinal cord compression
Offiah, 2021

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Conclusions
• Post-mortem CT has aided the identification of CPR-related injuries
• Can prevent misdiagnoses and determine extent of CPR injury,
amounting to cause of death
• Legal importance – within line of duty of care
• Ability to define methods which minimise injury and increase
chances of post-ROSC survival

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References
• Arai, Y., Honjo, S., Shimizu, S., Morimoto, M., Amisaki, M., Osaki, T., Tokuyasu, N., Sakamoto, T., Maeta, Y., Ashida, K., Saito, H. and Fujiwara, Y., 2017.
Traumatic Gastric Perforation Associated with Cardiopulmonary Resuscitation: A Case Report. Yonago Acta Medica, [online] 60(3), pp.204-208. Available at:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611477/> [Accessed 8 June 2021].
• Camden, J. and Carucci, L., 2011. Liver injury diagnosed on computed tomography after use of an automated cardiopulmonary resuscitation device. Emergency
Radiology, [online] 18(5), pp.429-431. Available at: <https://pubmed.ncbi.nlm.nih.gov/21468731/> [Accessed 8 June 2021].
• Cho, S., Kim, E., Choi, S., Kim, Y., Sung, Y., Choi, H., Cho, J. and Yang, H., 2013. Multidetector CT and radiographic findings of lung injuries secondary to
cardiopulmonary resuscitation. Injury, [online] 44(9), pp.1204-1207. Available at: <https://www.injuryjournal.com/article/S0020-1383(12)00454-8/fulltext> [Accessed
7 June 2021].
• Hamanaka, K., Nishiyama, K., Nakamura, M., Takaso, M. and Hitosugi, M., 2020. Both Autopsy and Computed Tomography Are Necessary for Accurately
Detecting Rib Fractures Due to Cardiopulmonary Resuscitation. Diagnostics, [online] 10(9), p.697. Available at:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556011/> [Accessed 8 June 2021].
• Hwang, S., Lieu, A., Lin, C., Liu, G., Howng, S. and Kuo, T., 2005. Massive cerebral air embolism after cardiopulmonary resuscitation. Journal of Clinical
Neuroscience, [online] 12(4), pp.468-469. Available at: <https://www.jocn-journal.com/article/S0967-5868(05)00037-8/references> [Accessed 8 June 2021].
• Kaewlai, R., Avery, L., Asrani, A. and Novelline, R., 2008. Multidetector CT of Blunt Thoracic Trauma. RadioGraphics, [online] 28(6), pp.1555-1570. Available at:
<https://pubs.rsna.org/doi/full/10.1148/rg.286085510> [Accessed 7 June 2021].
• Offiah, C. and Dean, J., 2016. Post-mortem CT and MRI: appropriate post-mortem imaging appearances and changes related to cardiopulmonary resuscitation. The
British Journal of Radiology, [online] 89(1058), p.20150851. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985223/> [Accessed 7 June 2021].
• Watanabe, S., Hyodoh, H., Shimizu, J., Okazaki, S., Mizuo, K. and Rokukawa, M., 2015. Classification of hemopericardium on postmortem CT. Legal Medicine,
[online] 17(5), pp.376-380. Available at: <https://www.sciencedirect.com/science/article/abs/pii/S1344622315000668> [Accessed 7 June 2021].

13. Thank you
Email address: a.baig@smd17.qmul.ac.uk
Co-Authors:
Curtis E Offiah MD & Nikolas P
Lemos PhD