BACKGROUND: Blunt trauma acting against the human body presents the fundamental cause of pulmonary fat embolism (PFE) and fat embolism syndrome. The aim of the present study was to investigate PFE in non-survivors after cardiopulmonary resuscitation (CPR). METHODS: This was a prospective cohort study conducted in University Hospital Ostrava, Czech Republic. Within a 4-year study period, all non-survivors after CPR because of out-of-hospital cardiac arrest were assessed for the study eligibility. The presence/seriousness of PFE was determined by microscopic examination of cryo-sections of lung tissue (staining with Oil Red O). RESULTS: In total, 106 persons after unsuccessful CPR were enrolled in the study. The most frequent cause of death in the study population (63.2% of cases) was cardiac disease (ischemic heart disease); PFE was not determined as the cause of death in any of our study cases. Sternal fractures were identified 66.9%, rib fractures (usually multiple) in 80.2% of study cases; the median number of rib fractures was 10.2 fractures per person. Serious intra-thoracic injuries were found in 34.9% of cases. Microscopic examination of lung cryo-sections revealed PFE in 40 (37.7%) study cases; PFE was most frequently evaluated as grade I or II. Occurrence of sternal and rib fractures was significantly higher in persons with PFE than between persons without PFE (p = 0.033 and p = <0.001). Number of rib fractures was also significantly higher in persons with PFE. The occurrence of serious intra-thoracic injuries was comparable in both our study groups (p = 0.089). CONCLUSIONS: PFE presents a common resuscitation injury which can be found in more than 30% of persons after CPR. Persons with resuscitation skeletal chest fractures have significantly higher risk of PFE development. During autopsy of persons after unsuccessful CPR, it is necessary to distinguish CPR-associated injuries including PFE from injuries that arise from other mechanisms.

• MeSH
• Embolism, Fat * complications   MeSH
• Rib Fractures * etiology   MeSH
• Cardiopulmonary Resuscitation * adverse effects   MeSH
• Humans MeSH
• Pulmonary Embolism * complications   MeSH
• Thoracic Injuries * etiology   MeSH
• Prospective Studies MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Plicní tuková embolie (PTE) je obvykle pozorována u osob se zlomeninami dlouhých kostí, u osob s rozsáhlými pohmožděninami tukové tkáně či popáleninami kožního krytu. Při poskytování nepřímé masáže srdce je tupé násilí směrováno proti střední části hrudníku, zlomeniny skeletu hrudníku pak představují nejčastější komplikaci nepřímé masáže srdce. Zlomeniny hrudníku vznikající v průběhu KPR jsou pravděpodobně nejčastější příčinou nálezu PTE při pitvě resuscitovaných osob. Cílem této práce je zkoumat prevalenci a závažnost PTE u zemřelých osob, u kterých byla před smrtí prováděna kardiopulmonální resuscitace. Ke vzniku PTE dochází u 30–42 % osob, kterým je poskytována nepřímá srdeční masáž; PTE přitom vzniká častěji u osob s resuscitačními zlomeninami skeletu hrudního koše. Pokud je KPR úspěšná, tuková embolie se pak může významnou měrou podílet na vzniku respiračního selhání (ARDS), resp. multiorgánového selhávání. Problematika poranění vznikajících při poskytování KPR má dva medicínské aspekty – klinický a forenzní. Z klinického hlediska je třeba resuscitační poranění zohlednit při poskytování zdravotní péče osobám, u kterých byla KPR úspěšná. Forenzní aspekt je třeba brát v úvahu při posuzování úrazových změn identifikovaných v průběhu autopsie (odlišení těchto nálezů od poranění, která vznikají jinými mechanizmy).

Pulmonary fat embolism (PFE) is usually observed in patients with long bone fractures, patients with extensive subcutaneous fat contusions or skin burns. Chest compressions during cardiopulmonary resuscitation (CPR) present powerful repetitive violence against victim’s chest. Skeletal chest fractures are the most frequent complication of CPR, and probably the most important cause of PFE autopsy finding in persons, which have been resuscitated before death. The aim of the present paper was to investigate the prevalence and seriousness of PFE in non-survivors after out-of-hospital cardiac arrest. During autopsy, PFE can be diagnosed in 30 – 42 % of persons after unsuccessful CPR; skeletal chest fractures are associated with significantly higher prevalence of PFE. After successful CPR, fat embolism may contribute significantly to acute respiratory distress syndrome, or multiorgan failure. The issue of CPR associated injuries has two medical aspects – clinical and forensic. From clinical point of view, the presence of CPR associated injuries must be acknowledged when offering healthcare to patients after successful CPR. During autopsy, CPR associated injuries should be diagnosed and evaluated as these injuries may contribute to death or may be potentially lethal.

• MeSH
• Adult MeSH
• Embolism, Fat * diagnosis   etiology   physiopathology   MeSH
• Fractures, Bone pathology   MeSH
• Rib Cage injuries   MeSH
• Cardiopulmonary Resuscitation * adverse effects   MeSH
• Cohort Studies MeSH
• Middle Aged MeSH
• Humans MeSH
• Heart Massage adverse effects   MeSH
• Autopsy MeSH
• Pulmonary Embolism diagnosis   etiology   physiopathology   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Hydrogen is a potent antioxidant agent that can easily be administered by inhalation. The aim of the study was to evaluate whether hydrogen protects the endothelial glycocalyx layer after successful cardiopulmonary resuscitation (CPR). METHODS: Fourteen anesthetized pigs underwent CPR after induced ventricular fibrillation. During CPR and return of spontaneous circulation, 2% hydrogen gas was administered to seven pigs (hydrogen group) and seven constituted a control group. Biochemistry and sublingual microcirculation were assessed at baseline, during CPR, at the 15th, 30th, 60th, 120th minute. RESULTS: All seven subjects from the hydrogen group and six subjects in the control group were successfully resuscitated after 6-10 minutes. At baseline, there were no statistically significant differences in examined variables. After the CPR, blood pH, base excess, and lactate showed significantly smaller deterioration in the hydrogen group than in the control group. By contrast, plasma syndecan-1 and the measured variables obtained via sublingual microcirculation did not change after the CPR; and were virtually identical between the two groups. CONCLUSION: In pigs, hydrogen gas inhalation during CPR and post-resuscitation care was associated with less pronounced metabolic acidosis compared to controls. However, we could not find evidence of injury to the endothelium or glycocalyx in any studied groups.

• MeSH
• Endothelium MeSH
• Glycocalyx MeSH
• Cardiopulmonary Resuscitation * MeSH
• Humans MeSH
• Disease Models, Animal MeSH
• Swine MeSH
• Reperfusion Injury * MeSH
• Heart Arrest * therapy   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

AIM: There have been no direct comparisons of cardiopulmonary resuscitation (CPR)-related injuries between those who die during CPR and those who survive to intensive care unit (ICU) admission. This study aimed to compare the incidence, severity, and impact on survival rate of these injuries and potential influencing factors. METHOD: This retrospective multicenter study analyzed autopsy reports of patients who experienced out-of-hospital cardiac arrest (OHCA) and were not admitted to hospital. CPR-related injuries were compared to OHCA patients with clinical suspicion of CPR-related injury confirmed on imaging when admitted to the ICU. RESULTS: A total of 859 out-of-hospital cardiac arrests (OHCA) were divided into 2 groups: those who died during CPR and underwent autopsy (DEAD [n = 628]); and those who experienced return of spontaneous circulation and admitted to the ICU (ICU [n = 231]). Multivariable analyses revealed that independent factors of 30-day mortality included no bystander arrest, cardiac etiology, no shockable rhythm, and CPR-related injury. Trauma was independently associated with older age, bystander CPR, cardiac etiology, duration of CPR, and no defibrillation. CPR-related injury occurred in 30 (13%) patients in the ICU group and 547 (87%) in the DEAD group (p < 0.0001). Comparison of injuries revealed that those in the DEAD group experienced more thoracic injuries, rib(s) and sternal fractures, and fewer liver injuries compared to those in the ICU group, without differences in injury severity. CONCLUSION: CPR-related injuries were observed more frequently in those who died compared with those who survived to ICU admission. Injury was an independent factor of 30-day mortality.

• MeSH
• Cardiopulmonary Resuscitation * adverse effects   methods   MeSH
• Humans MeSH
• Survivors MeSH
• Retrospective Studies MeSH
• Emergency Medical Services * MeSH
• Out-of-Hospital Cardiac Arrest * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH

Úvod: Atlantookcipitální disociace (AOD) je vzácné nestabilní poranění kraniocervikálního přechodu doprovázené velmi vysokou mortalitou a morbiditou. Nejčastější příčinou je vysokoenergetické trauma s hyperextenzí lebky v rámci dopravních nehod. Vzhledem k anatomickým predispozicím jsou nejčastější postiženou skupinou děti a mladší dospělí. Zlepšující se systém akutní přednemocniční a časné nemocniční péče vede ke vzrůstajícímu záchytu tohoto poranění. Metody: Retrospektivní analýzou všech poranění krční páteře ošetřených v rámci traumacentra Masarykovy nemocnice v Ústí nad Labem v intervalu deseti let mezi roky 2008 a 2018 bylo identifikováno 7 pacientů s atlantookcipitální disociací. Soubor tvořilo 5 mužů a 2 ženy. Průměrný věk pacientů byl 19,6 roku, přičemž nejmladšímu pacientovi bylo 9 let a nejstaršímu 35. Ve všech případech se jednalo o dopravní nehodu. Výsledky: U všech pacientů bylo na základě CT vyšetření diagnostikováno vysoce nestabilní poranění segmentu C0-C1. Čtyři pacienti zemřeli během pokračující kraniocerebropulmonální resuscitace ještě na oddělení emergency. Dva pacienti s nepříznivým neurologickým obrazem a MR verifikovanou lézí přechodu prodloužené a horní krční míchy byli ošetřeni halo fixací a zemřeli do 3 dnů od úrazu. Pouze jeden pacient s novou deteriorací neurologického stavu během vyšetřovacího procesu byl úspěšně řešen otevřenou akutní zadní kraniocervikální fixací a fúzí. Závěr: Vzrůstající incidence AOD zvyšuje nároky na včasnou diagnózu minimalizující riziko následné klinické deteriorace. Diagnostickou metodu volby je CT hodnocení kondyl-C1 intervalu (CCI) v kombinaci s MR vyšetřením. Standardní léčbou instabilních AOD u stabilizovaných pacientů je časná zadní okcipitocervikální stabilizace a fúze v rozsahu C0-C2.

Introduction: Atlanto-occipital dissociation (AOD) is a rare and unstable injury of the craniocervical junction, associated with very high morbidity and mortality. The most common cause of this injury is high energy trauma with hyperextension of the cranium, such as car accidents. Due to specific anatomical predispositions, children and young adults are the frequently affected populations. Improving pre-hospital and early emergency care has resulted in a higher sensitivity of AOD diagnosis.Methods: A retrospective analysis of all patients with cervical spine trauma, treated at the Masaryk Hospital Trauma Center between 2008 and 2018, identified 7 patients with AOD. The cohort consisted of 5 males and 2 females, with a mean age of 19,6 years and with the age range 9 to 35 years. All cases occurred as a result of a car accident. Results: All patients in the cohort had findings of a highly unstable C0-C1 injury on their CT scans on admission. Four patients died early, while undergoing CPR in the emergency department. Two patients were in severe neurological states, with lesions of the upper cervical spinal cord and medulla oblongata on MRI. These patients were treated with external halo fixation and died within 3 days of the trauma. Only one patient with a new progressive neurological deficit was successfully treated using acute occipitocervical stabilization and fusion. Conclusion: The increasing incidence of AOD requires an early diagnosis, which minimizes the risk of successive clinical deterioration. The diagnostic method of choice is the C1-condyle interval (CCI) CT assessment along with cervical spine MRI. Standard treatment of stable patients with unstable AOD injuries consists in posterior occipitocervical stabilization and fusion of C0-C2.

• MeSH
• Atlanto-Occipital Joint * surgery   pathology   injuries   MeSH
• Joint Dislocations * diagnostic imaging   surgery   mortality   MeSH
• Child MeSH
• Accidents, Traffic MeSH
• Adult MeSH
• Spinal Fusion MeSH
• Cervical Vertebrae surgery   pathology   injuries   MeSH
• Humans MeSH
• Adolescent MeSH
• Retrospective Studies MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH

Cieľom tejto prospektívnej autoptickej štúdie bolo vyhodnotiť množstvo a závažnosť poranení vznikajúcich v súvislosti s kardiopulmonálnou resuscitáciou (KPR) na kohorte osôb zomrelých na území Moravsko-sliezskeho kraja. V sledovanom období bolo do štúdie celkovo zaradených 80 osôb, u ktorých bola pred smrťou vykonávaná KPR kvôli zástave srdca, ktorá nebola spôsobená mechanickou traumou. KPR asociované poranenia boli identifikované u 75 (93,7 %) osôb, pričom u 73 osôb sa jednalo o viacnásobné poranenia. V niektorých prípadoch sa jednalo až o život ohrozujúce poranenia (za predpokladu, že by u týchto osôb došlo k obnoveniu obehu).

The aim of the present study is to investigate incidence and seriousness of CPR-associated injuries on a cohort of CPR non-survivors after out-of-hospital cardiac arrest in the Moravian-Silesian region. In total, 80 persons were included in the study within the study period (2012 – 2015). CPR-associated injuries were identified in 75 (93.7 %) persons, multiple injuries were found in 73 persons. Spectrum of identified injuries covered skin injuries of the upper half of the body, head and neck injuries, rare abdominal injuries and very frequent thorax injuries. Sternal fractures were found in 53 (63.3 %) persons. Rib fractures were identified in 59 (73.0 %) persons; rib fractures were usually multiple (mean number of broken ribs was 7.6 per person). Intra-thoracic injuries were diagnosed in 33 (41.2 %) persons – findings of lung contusions and lacerations, transmural heart contusions, hemothorax and hemopericard. The vast majority of identified intra-thoracic injuries were considered clinically relevant (provided the fact that return of spontaneous circulation had been achieved). Intraabdominal injuries (liver and spleen injuries) were identified in 15 (18.7 %) of persons. Vast majority of these injuries was clinically irrelevant. We have found clinically serious injuries (spleen rupture and liver dilacerations) in 3 (3.7 %) persons. Outcomes of our study suggest that CPR-associated injuries are very common, usually multiple, and in some cases they might be even potentially lethal (if return of spontaneous circulation is achieved).

• MeSH
• Rib Fractures etiology   MeSH
• Iatrogenic Disease * MeSH
• Cardiopulmonary Resuscitation * MeSH
• Cohort Studies MeSH
• Humans MeSH
• Autopsy MeSH
• Cause of Death MeSH
• Prospective Studies MeSH
• Sternum injuries   MeSH
• Out-of-Hospital Cardiac Arrest MeSH
• Check Tag
• Humans MeSH

Cíl studie: Kvantifikovat výskyt poresuscitačních traumat u pacientů po neúspěšně resuscitaci. Typ studie: Retrospektivní observační. Pracoviště: Krajská zdravotnická záchranná služba. Materiál a metoda: Do studie bylo zahrnuto 107 pitvaných pacientů po kardiopulmonální resuscitaci po netraumatické náhlé zástavě oběhu za rok 2015. U této skupiny jsme vyhledali pacienty, kteří měli v pitevním protokolu popsané závažné poresuscitační trauma. U těchto pacientů jsme provedli analýzu výjezdové dokumentace v systému ZZS. Tuto skupinu jsme dále porovnávali s celkovým počtem 394 kardiopulmonálních resuscitací v témže období. Výsledky: U 61 pitvaných pacientů po resuscitaci (tj. 57 %, respektive vztaženo k celkovému počtu resuscitací 15,5 %) byly při pitvě nalezeny traumatické změny, které nelze vykládat jinak, než jako následek kompresí hrudníku. Zároveň není možné považovat za jedinou příčinu nešetrnou laickou resuscitaci, 23 (37,7 %) resuscitací s traumatem bylo totiž provedeno pouze složkami integrovaného záchranného systému, ani biologická křehkost pacienta, protože 37 (60,7 %) těchto resuscitací proběhlo u pacientů mladších 70 let. Závěr: Je nutné další vzdělávání jak laiků, tak i zaměstnanců integrovaného záchranného systému s požadavkem přizpůsobení resuscitačního úsilí tělesné konstituci pacienta, zvláště u posádek záchranné služby. Další výzkum resuscitačních traumat je nezbytný.

Objective: Quantification of the incidence of CPR-related injuries in unsuccessfully resuscitated out-of-hospital cardiac arrest patients. Design: Retrospective observational study. Setting: Regional emergency medical services. Materials and methods: The study included the autopsy protocols of all 107 patients unsuccessfully resuscitated fol­lowing non-traumatic out-of-hospital cardiac arrest in the year 2015. We identified all the patients with CPR-related trauma. These patients’ medical reports from the emergency information system were then analysed. They were compared to all the 394 resuscitations performed in the region in 2015. Results: CPR-associated major trauma of the chest and upper abdomen was found in 61 autopsy protocols (57% incidence in the deceased group; theoretically at least 15.5% incidence in all the resuscitations). This is most likely to be caused by chest compressions. Twenty three (37 %) of the resuscitations with post-CPR trauma were conducted by the rescue services only and 37 (60.7 %) of the resuscitated patients with post-CPR trauma were younger than 70 years, therefore not all the post-CPR trauma can be ascribed to CPR by lay-persons or the frailty of the patients. Conclusion: Further education of the general public in BLS and the adjustment of compressions to the body constitution of the particular patient need to be emphasized in the education of healthcare specialists, especially paramedics and EMS physicians. Further research of post-CPR trauma is necessary.

• Keywords
• mimonemocniční zástava oběhu,
• MeSH
• Adult MeSH
• Fatal Outcome MeSH
• Rib Fractures epidemiology   etiology   MeSH
• Cardiopulmonary Resuscitation * adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Heart Massage adverse effects   MeSH
• Autopsy MeSH
• Thoracic Injuries * epidemiology   etiology   MeSH
• First Aid adverse effects   MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Sternum injuries   MeSH
• Emergency Medical Services MeSH
• Age Distribution MeSH
• Out-of-Hospital Cardiac Arrest * therapy   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Observational Study MeSH
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Defibrillators, Implantable MeSH
• Implantable Neurostimulators MeSH
• Cardiopulmonary Resuscitation MeSH
• Pacemaker, Artificial MeSH
• Ethics, Medical MeSH
• Palliative Care MeSH
• Terminal Care MeSH
• Heart Arrest MeSH
• Legislation, Medical MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• kardiologie
• technika lékařská, zdravotnický materiál a protetika
• NML Publication type
• brožury

AIM OF THE STUDY: The aim of the study was to evaluate prevalence, seriousness and risk factors of intra-thoracic injuries (ITI) injuries associated with CPR in non-survivors after out-of-hospital cardiac arrest. METHODS: This was a prospective forensic autopsy cohort study conducted in a single institution. Pathologists recorded autopsy data using standardized protocol which contained data from external and internal examination of the body focused on ITI. RESULTS: In total, 80 persons were included in this study. CPR-associated injuries were found in 93.7% of cases; majority of injuries were skeletal chest fractures (rib fractures in 73.7%, sternal fractures in 66.3%). ITI were identified in 41.2% of cases. Contusion of at least one lung lobe was found in 31.2%, lung laceration in 2.5%, and hemothorax in 5.0% of cases. Transmural heart contusion was identified in 17.5% of cases; hemopericard on the grounds of right atrium rupture of aortic rupture was revealed in 8.7% of cases. Risk factor analysis did not show any statistically significant correlation between ITI and any of general data (age, gender, BMI, cause of death, season of the year or location where the body was found) or CPR specifications (type and duration of CPR, manner of chest compressions). A strong correlation between ITI and skeletal chest fractures was proven. CONCLUSION: ITI present frequent and serious complications of unsuccessful CPR. ITI could contribute to the death only provided the fact that ROSC had been achieved. Correct performance of chest compressions according to guidelines is the best way to avoid ITI.

• MeSH
• Cardiopulmonary Resuscitation adverse effects   mortality   MeSH
• Middle Aged MeSH
• Humans MeSH
• Autopsy statistics & numerical data   MeSH
• Thoracic Injuries epidemiology   MeSH
• Cause of Death MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Out-of-Hospital Cardiac Arrest mortality   therapy   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Tonutí stále patří k závažným problémům pediatrické intenzivní péče. Autoři popisují tonutí 2letého chlapce v biologicky kontaminované vodě. Prognóza dítěte byla velmi nepříznivá, došlo k rozvoji extrémní acidózy, podchlazení < 30 °C a těžkému plicnímu poškození na podkladě aspirace. Okamžitě zahájená laická resuscitace a následná komplexní léčba vedla k úplnému uzdravení dítěte. Kazuistika je doplněna potřebnými informacemi o této závažné problematice se zdůrazněním významu prevence.

Drowning belongs to important topics of intensive care in paediatrics. The authors describe a case of a 2-year-old boy who near-drowned in biologically contaminated water. Child's prognosis was very serious, he developed extreme acidosis, hypothermia <30°C and a severe pulmonary injury caused by aspiration. Immediate lay resuscitation followed by complex treatment led to a complete recovery of the child. The case is provided with necessary information about this serious topic with emphasis on prevention.

• MeSH
• Acidosis MeSH
• Respiratory Aspiration MeSH
• Barotrauma MeSH
• Glasgow Coma Scale MeSH
• Hypothermia MeSH
• Hypoxia MeSH
• Cardiopulmonary Resuscitation MeSH
• Infant MeSH
• Humans MeSH
• Sewage adverse effects   MeSH
• Critical Care * methods   MeSH
• Lung Injury * diagnosis   therapy   MeSH
• Respiratory Distress Syndrome complications   therapy   MeSH
• Respiration, Artificial MeSH
• Near Drowning * complications   physiopathology   therapy   MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH