Matshes Evan W, Lew Emma O
Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada.
Am J Forensic Med Pathol. 2010 Jun;31(2):178-85. doi: 10.1097/PAF.0b013e3181df62ee.
Occasionally, individuals accused of inflicting fatal injuries on infants and young children will claim some variant of the "CPR defense," that is, they attribute the cause of injuries found at autopsy to their "untrained" resuscitative efforts. A 10-year (1994-2003) historical fixed cohort study of all pediatric forensic autopsies at the Miami-Dade County Medical Examiner Department was undertaken. To be eligible for inclusion in the study, children had to have died of atraumatic causes, with or without resuscitative efforts (N(atraumatic) = 546). Of these, 382 had a history of cardiopulmonary resuscitation (CPR; average age of 4.17 years); 248 had CPR provided by trained individuals only; 133 had CPR provided by both trained and untrained individuals; 1 had CPR provided by untrained individuals only. There was no overlap between these 3 distinct groups. Twenty-two findings potentially attributable to CPR were identified in 19:15 cases of orofacial injuries compatible with attempted endotracheal intubation; 4 cases with focal pulmonary parenchymal hemorrhage; 1 case with prominent anterior mediastinal emphysema; and 2 cases with anterior chest abrasions. There were no significant hollow or solid thoracoabdominal organ injuries. There were no rib fractures. The estimated relative risk of injury subsequent to resuscitation was not statistically different between the subset of decedents whose resuscitative attempts were made by trained individuals only, and the subset who received CPR from both trained and untrained individuals. In the single case of CPR application by an untrained individual only, no injuries resulted. The remaining 164 children dying from nontraumatic causes and who did not undergo resuscitative efforts served as a control group; no injuries were identified. This study indicates that in the pediatric population, injuries secondary to resuscitative efforts are infrequent or rare, pathophysiologically inconsequential, and predominantly orofacial in location. In our population, CPR did not result in any rib fractures or significant visceral injuries. Participation of nonmedical or untrained individuals in resuscitation did not increase the likelihood of injury.
偶尔，被指控对婴幼儿造成致命伤害的人会声称某种形式的“心肺复苏术抗辩”，也就是说，他们将尸检中发现的损伤原因归咎于自己“未经培训”的复苏努力。迈阿密-戴德县法医部门对所有儿科法医尸检进行了一项为期10年（1994 - 2003年）的历史性固定队列研究。要符合纳入该研究的条件，儿童必须死于非创伤性原因，无论是否进行过复苏努力（非创伤性死亡人数 = 546）。其中，382名有心肺复苏术（CPR）史（平均年龄4.17岁）；248名仅由受过培训的人员进行心肺复苏；133名由受过培训和未受过培训的人员共同进行心肺复苏；1名仅由未受过培训的人员进行心肺复苏。这3个不同组之间没有重叠。在19例（15例与试图气管插管相符的口面部损伤、4例局灶性肺实质出血、1例前纵隔明显气肿、2例前胸擦伤）病例中确定了22项可能归因于心肺复苏术的发现。没有明显的胸腹部中空或实性器官损伤。没有肋骨骨折。仅由受过培训的人员进行复苏尝试的死者亚组与接受过培训和未受过培训的人员共同进行心肺复苏的亚组相比，复苏后受伤的估计相对风险在统计学上没有差异。在仅由未受过培训的人员进行心肺复苏的单个病例中，未造成损伤。其余164名死于非创伤性原因且未接受复苏努力的儿童作为对照组；未发现损伤。这项研究表明，在儿科人群中，复苏努力导致的损伤很少见或罕见，在病理生理上无关紧要，且主要位于口面部。在我们的人群中，心肺复苏术未导致任何肋骨骨折或严重的内脏损伤。非医疗或未受过培训的人员参与复苏并未增加受伤的可能性。
