Ihnát Rudinská Lucia, Hejna Petr, Ihnát Peter, Tomášková Hana, Smatanová Margita, Dvořáček Igor
Department of Forensic Medicine, University Hospital Ostrava, 17.listopadu 1790, Ostrava 70852, Czech Republic; Department of Intensive Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic.
Department of Forensic Medicine, University Hospital Hradec Králové, Sokolská 581, Hradec Králové 500 05, Czech Republic.
Resuscitation. 2016 Jun;103:66-70. doi: 10.1016/j.resuscitation.2016.04.002. Epub 2016 Apr 16.
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.
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.
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.
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.
本研究旨在评估院外心脏骤停后非存活者中与心肺复苏相关的胸内损伤（ITI）的发生率、严重程度及危险因素。
这是一项在单一机构进行的前瞻性法医尸检队列研究。病理学家使用标准化方案记录尸检数据，该方案包含针对ITI的尸体外部和内部检查数据。
本研究共纳入80人。93.7%的病例发现有与心肺复苏相关的损伤；大多数损伤为胸骨骨折（肋骨骨折占73.7%，胸骨骨折占66.3%）。41.2%的病例发现有ITI。31.2%的病例发现至少一个肺叶挫伤，2.5%的病例发现肺撕裂伤，5.0%的病例发现血胸。17.5%的病例发现透壁性心脏挫伤；8.7%的病例因右心房破裂或主动脉破裂发现心包积血。危险因素分析未显示ITI与任何一般数据（年龄、性别、体重指数、死因、一年中的季节或发现尸体的地点）或心肺复苏规范（心肺复苏的类型和持续时间、胸外按压方式）之间存在任何统计学上的显著相关性。已证实ITI与胸骨骨折之间存在强相关性。
ITI是心肺复苏失败常见且严重的并发症。仅在实现自主循环恢复的情况下，ITI才可能导致死亡。按照指南正确进行胸外按压是避免ITI的最佳方法。
