Cardiothoracic injuries and mechanical cardiopulmonary resuscitation – A forensic autopsy convenience control study on 436 cases

This study documents the types and frequencies of injuries related to chest compressions during resuscitation attempts in a cohort of 436 non-traumatic, forensic autopsy cases from Eastern Denmark. We hypothesized that there would be a difference in types and frequencies of injuries seen after mechanical cardiopulmonary resuscitation (mCPR) compared to manual basic life support (BLS). We included all non-traumatic deaths referred for a forensic autopsy in eastern Denmark in the period 2015-2017, for a total of 436 cases (females, n = 146; males, n = 290), of which 75 cases had mCPR performed. Data on injuries were obtained from forensic autopsy reports. The mCPR group was characterized by a statistically significantly higher incidence of myocardial rupture (4 % vs. 0 %, p < 0.0001). We found no other statistically significant differences in the incidence of visceral trauma (e.g. haemothorax, pericardial haemorrhage, pulmonary contusions, liver or spleen injuries) between the two groups. In addition, characteristic injuries recorded in both groups included a high frequency of multiple rib fractures in the upper and middle parts of the rib cage, primarily located anteriorly, as well as sternum fractures, but these findings occurred almost twice as much in the mCPR group (77.3 % vs. 46.8 %, p < 0.0001).