Maxeiner H, Jekat R
Charité-Department of Legal Medicine, University Medicine of Berlin, Turmstr. 21, D-10559 Berlin, Germany.
J Forensic Leg Med. 2010 Feb;17(2):87-91. doi: 10.1016/j.jflm.2009.09.010. Epub 2009 Oct 6.
In recent years, cardiopulmonary resuscitation (CPR) has been discussed as a cause of petechial hemorrhage in eyelids and conjunctivae, which could be of substantial significance to forensic expertises in cases of suspected strangulation. In the reported series or case observations, the combination of CPR and petechiae seemed to be sufficient to explain such a causal connection. Nearly all presented cases were victims for which the mechanisms resulting in death were themselves well-known causes explaining the development of such petechiae; and said mechanisms can frequently be observed in victims that did not receive CPR. An earlier, also retrospective, analysis of a series of forensic autopsies did not confirm CPR as a significant cause of conjunctival petechiae. Now we present the result of a prospective examination of 196 resuscitations of adult patients with separate assessment of petechiae being present even prior to resuscitation. Petechiae were present in 12 cases - but in eight of them prior to resuscitation already. Three other persons with petechiae found only after CPR were in the group of successfully resuscitated persons and exhibited petechiae hours after CPR during therapy in intensive care units - during a phase of ongoing cardiac insufficiency, which obviously caused them. The only case with petechiae observed neither immediately prior to nor after unsuccessful resuscitation, but during a follow-up examination one day later, needs to be discussed. It is not interpreted as reliable evidence for the causality of CPR though. Our interpretation of reports in literature as well as our experiences confirm the absence of actual proof of petechiae being generated by CPR and in the presence of generally significant doubts of this relation.
近年来，心肺复苏术（CPR）一直被作为眼睑和结膜瘀点出血的一个原因来讨论，这对于疑似勒死案件的法医鉴定可能具有重大意义。在已报道的系列病例或病例观察中，心肺复苏术和瘀点的并存似乎足以解释这种因果关系。几乎所有已报道的病例，其导致死亡的机制本身就是众所周知的可解释此类瘀点形成的原因；而且在未接受心肺复苏术的受害者中也经常能观察到这些机制。一项早期的、同样是回顾性的对一系列法医尸检的分析并未证实心肺复苏术是结膜瘀点的一个重要成因。现在我们展示对196例成年患者进行复苏的前瞻性检查结果，对复苏前是否存在瘀点进行单独评估。有12例出现了瘀点——但其中8例在复苏前就已经有瘀点了。另外3例在心肺复苏术后才发现有瘀点的患者属于成功复苏组，并且是在重症监护病房治疗期间，即持续存在心功能不全的阶段出现瘀点的，显然是心功能不全导致了瘀点出现。唯一一例在复苏未成功前及之后均未观察到瘀点，而是在一天后的随访检查中发现瘀点的情况，仍需探讨。不过，这并未被视为心肺复苏术导致瘀点的可靠证据。我们对文献报道的解读以及我们的经验都证实，目前缺乏心肺复苏术导致瘀点的实际证据，且对此关系普遍存在重大疑问。
