Obduktionsbefunde und Interpretation nach frustraner Reanimation

Zusammenfassung

Reanimationsmaßnahmen (externe Herzdruckmassage, [Früh-]Defibrillation, Atemwegssicherung, Medikamenten- und Volumenapplikation) können potenziell lebensrettend sein, beinhalten allerdings z. T. nicht unerhebliche Verletzungsrisiken für den Patienten, welche allein oder in Kombination nicht nur den initialen Erfolg der Reanimationsbemühungen limitieren, sondern auch nach inital erfolgreicher Wiederbelebung im klinischen Verlauf zu schwerwiegenden Komplikationen führen können. Wir berichten in der Synopsis aus Literatur und Obduktionsbefunden nach frustranen Wiederbelebungsversuchen über entsprechende medizinische und medikolegale Implikationen von reanimationsbedingten Verletzungen.

Abstract

Resuscitation techniques (external cardiac massage, [early] defibrillation, airway management, application of drugs and infusions) may be potentially live-saving, but they also contain a significant risk of injury for the patient. These resuscitation-related injuries – solitary or combined – might not only limit the success of the initial resuscitation attempts but they can also complicate the clinical course after primarily successful resuscitation. In the subsumption of literature and autopsy findings after unsuccessful resuscitation attempts, we report about medical and medicolegal implications of resuscitation-related trauma.

Schlüsselwörter

Reanimation - Reanimationsverletzungen - Notfallmedizin - Obduktion

Keywords

resuscitation - resuscitation-related injuries - emergency medicine - autopsy

• Literatur

• 1 Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed chest cardiac massage. JAMA 1960; 173: 1064-1067
• 2 Lown B, Amarasingham R, Neuman J. New method for terminating cardiac arrhythmias. Use of synchronized capacitor discharge. JAMA 1962; 182: 548-555
• 3 Safar P, Brown TC, Holtey WJ et al. Ventilation and circulation with closed-chest cardiac massage in man. JAMA 1961; 176: 574-576
• 4 European Resuscitation Council Guidelines for Resuscitation 2010. www.erc.edu zuletzt aufgerufen am 11. Juni 2012
• 5 Buschmann C, Tsokos M. Iatrogene Traumata nach frustraner Reanimation. Der Notarzt 2008; 24: 197-202
• 6 Baubin M, Sumann G, Rabl W et al. Increased frequency of thorax injuries with ACD-CPR. Resuscitation 1999; 41: 33-38
• 7 Blomberg H, Gedeborg R, Berglund L et al. Poor chest compression quality with mechanical compressions in simulated cardiopulmonary resuscitation: a randomized, cross-over manikin study. Resuscitation 2011; 82: 1332-1337
• 8 Smekala D, Johansson J, Huzevkaa T et al. No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCASTM device – A pilot study. Resuscitation 2009; 80: 1104-1107
• 9 Xanthos T, Pantazopoulos I, Roumelioti H et al. A comparison of autopsy detected injuries in a porcine model of cardiac arrest treated with either manual or mechanical chest compressions. Eur J Emerg Med 2011; 18: 108-110
• 10 Buschmann C, Gahr P, Ertel W et al. Clinical diagnosis versus autopsy findings in polytrauma fatalities. Scand J Trauma Resusc Emerg Med 2010; 18: 55
• 11 Delguercio LR, Feins NR, Cohn JD et al. Comparison of blood flow during external and internal cardiac massage in man. Circulation 1965; 31: 171-180
• 12 Duchateau FX, Gueye P, Curac S et al. Effect of the AutoPulse™ automated band chest compression device on hemodynamics in out-of-hospital cardiac arrest resuscitation. Intensive Care Med 2010; 36: 1256-1260
• 13 Lederer W, Mair D, Rabl W et al. Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray. Resuscitation 2004; 60: 157-162
• 14 Kröner C, Maissen P, Reichenstein D et al. Pathologische Wirbelkörperfraktur nach kardiopulmonaler Reanimation. Notfall Rettungsmed 2011; 14: 488-490
• 15 Buschmann C, Zechmeister E, Schulz F. Verzögerte Myokardperforation durch Mitralklappenringfraktur nach primär erfolgreicher Reanimation. Notfall Rettungsmed 2009; 13: 52-57
• 16 Klintschar M, Darok M, Radner H. Massive injury to the heart after attempted active compression-decompression cardiopulmonary resuscitation. Int J Legal Med 1998; 111: 93-96
• 17 Noffsinger AE, Blisard KS, Balko MG. Cardiac laceration and pericardial tamponade due to cardiopulmonary resuscitation after myocardial infarction. J Forensic Sci 1991; 36: 1760-1764
• 18 Sokolove PE, Willis-Shore J, Panacek EA. Exsanguination due to right ventricular rupture during closed-chest cardiopulmonary resuscitation. J Emerg Med 2002; 23: 161-164
• 19 Black C, Busuttil A, Robertson C. Chest wall injuries following cardiopulmonal resuscitation. Resuscitation 2004; 63: 339-343
• 20 Bode G, Joachim H. Zur Differentialdiagnose von Unfall- und Reanimationstraumen. Z Rechtsmed 1987; 98: 19-32
• 21 Hoke R, Chamberlain D. Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation 2004; 63: 327-338
• 22 Klöss T, Püschel K, Wischhusen F et al. Reanimationsverletzungen. Anasth Intensivther Notfallmed 1983; 18: 199-203
• 23 Zenda T, Takayama T, Miyamoto M et al. Intravascular gas in multiple organs detected by postmortem computed tomography: effect of prolonged cardiopulmonary resuscitation on organ damage in patients with cardiopulmonary arrest. Jpn J Radiol 2011; 29: 148-151
• 24 Carstens PH. Pulmonary bone marrow embolism following external cardiac massage. Acta Pathol Microbiol Scand 1969; 76: 510-514
• 25 Dziecioł J, Kemona A, Górska M et al. Widespread myocardial and pulmonary bone marrow embolism following cardiac massage. Forensic Sci Int 1992; 56: 195-199
• 26 Kager LM, Wegener RP. A woman who died despite resuscitation. Pulmonary bone marrow embolism secondary to a sternum fracture. Ned Tijdschr Geneeskd 2007; 151: 695
• 27 Hashimoto Y, Moriya F, Furumiya J. Forensic aspects of complications resulting from cardiopulmonary resuscitation. Legal Med 2007; 9: 94-99
• 28 Deakin CD, Nolan JP, Soar J et al. European resuscitation council guidelines for resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2010; 81: 1305-1352
• 29 Cummins RO. From concept to standard-of-care? Review of the clinical experience with automated external defibrillators. Ann Emerg Med 1989; 18: 1269-1275
• 30 Hojs R, Sinkovic A, Hojs-Fabjan T. Rhabdomyolysis and acute renal failure following cardioversion and cardiopulmonary resuscitation. Ren Fail 1995; 17: 765-768
• 31 Minor Jr RL, Chandran PK, Williams CL. Rhabdomyolysis and myoglobinuric renal failure following cardioversion and CPR for acute MI. Chest 1990; 97: 485-486
• 32 Saukko P, Knight B. The forensic autopsy. In: Saukko P, Knight B. Knight’s Forensic Pathology. 3rd. edition, London: Hodder Arnold; 2004: 40-41
• 33 Karch SB. Resuscitation-induced myocardial necrosis – Catecholamines and defibrillation. Am J Forensic Med Pathol 1987; 8: 3-8
• 34 Buschmann C, Kleber C, Schulz T et al. Notfallmedizin aktuell – Obduktionsbefunde. Rechtsmedizin 2012; 22: 197-216
• 35 Saternus KS, Fuchs V. Verletzungen der A. carotis communis durch Reanimationsmaßnahmen. Z Rechtsmed 1982; 88: 305-311
• 36 Divatia JV, Bhowmick K. Complications of endotracheal intubation and other airway management procedures. Indian J Anaesth 2005; 49: 308-318
• 37 Jaeger K, Ruschulte H, Osthaus A et al. Tracheal injury as a sequence of multiple attempts of endotracheal intubation in the course of a preclinical cardiopulmonary resuscitation. Resuscitation 2000; 43: 147-150
• 38 Maxeiner H. Weichteilverletzungen am Kehlkopf bei notfallmäßiger Intubation. Anästh Intensivmed 1988; 29: 42-49
• 39 Bernard M, Matthes G, Kanz KG et al. Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma. Anästhesist 2011; 60: 1027-1040
• 40 Matevossian E, Sinicina I, Thorban S et al. Oesophago-gastric muscular rupture after resuscitation. ANZ J Surg 2008; 78: 719
• 41 Lawes EG, Baskett PJ. Pulmonary aspiration during unsuccessful cardiopulmonary resuscitation. Intensive Care Med 1987; 13: 379-382
• 42 Moustoukas N, Litwin MS. Intracranial placement of nasogastric tube: an unusual complication. South Med J 1983; 76: 816-817
• 43 Hanumanthaiah D, Masud S, Ranganath A. Inferior alveolar nerve injury with laryngeal mask airway: a case report. J Med Case Rep 2011; 5: 122
• 44 Buschmann C, Niebuhr N, Schulz T et al. „SAR-First-Responder Sea“ – backgrounds to a medical education concept in German SAR service. Int Marit Health 2009; 60: 43-47
• 45 Vézina MC, Trépanier CA, Nicole PC et al. Complications associated with the Esophageal-Tracheal Combitube in the pre-hospital setting. Can J Anaesth 2007; 54: 124-128
• 46 Wiese CHR, Semmel T, Müller JU et al. The use of the laryngeal tube disposable (LT-D) by paramedics during out-of-hospital resuscitation – An observational study concerning ERC guidelines 2005. Resuscitation 2009; 80: 194-198
• 47 Helm M, Hossfeld B, Jost C et al. Chirurgische Atemwegssicherung in der präklinischen Notfallmedizin. Notfall Rettungsmed 2011; 14: 29-36
• 48 Breitmeier D, Schulz Y, Wilke N et al. Koniotomieübungen an der Leiche – Erfahrungen in der Ausbildung mit Medizinstudenten, Anästhesisten und Notärzten. Anästhesiol Intensivmed Notfallmed Schmerzther 2004; 39: 94-100
• 49 Timmermann A. Modernes Atemwegsmanagement – Aktuelle Konzepte für mehr Patientensicherheit. Anästhesiol Intensivmed Notfallmed Schmerzther 2009; 44: 246-255
• 50 Neuhaus D. Intraossärer Zugang. Notfall Rettungsmed 2011; 14: 543-548
• 51 Weiss M, Gächter-Angehrn J, Neuhaus D. Intraossäre Infusionstechnik. Notfall Rettungsmed 2007; 10: 99-116
• 52 Schröder AS, Püschel K, Anders S. Stichbeibringung an den Beinen? Fallstricke bei der äußeren Leichenschau nach notärztlicher Behandlung. Rechtsmedizin 2010; 20: 515-518
• 53 Buschmann C, Hunsaker III JC, Correns A et al. Blunt head trauma or extensive tension pneumothorax?. Forensic Sci Med Pathol 2012; 8: 73-75
• 54 Hopson LR, Hirsh E, Delgado J et al. Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: joint position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. J Am Coll Surg 2003; 196: 106-112
• 55 Sandroni C, Nolan J. ERC 2010 guidelines for adult and pediatric resuscitation: summary of major changes. Minerva Anestesiol 2011; 77: 220-226
• 56 Huber-Wagner S, Lefering R, Qvick M et al. Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest. Resuscitation 2007; 75: 276-285
• 57 Mistry N, Bleetman A, Roberts KJ. Chest decompression during the resuscitation of patients in prehospital traumatic cardiac arrest. Emerg Med J 2009; 26: 738-740
• 58 Schulz F, Kontokollias JS. Tödliche Thoraxstichverletzung – ungewöhnliche Komplikation bei der Reanimation. Rettungsdienst 1992; 15: 45-48
• 59 Kortbeek JB, Al Turki SA, Ali J et al. Advanced trauma life support. 8th edition, the evidence for change. J Trauma 2008; 64: 1638-1650
• 60 Bleetman A, Dyer J. Ultrasound assessment of the vulnerability of the internal organs to stabbing: determining safety standards for stab-resistant body armour. Injury 2000; 31: 609-612
• 61 Connor SE, Bleetman A, Duddy MJ. Safety standards for stab-resistant body armour: a computer tomographic assessment of organ to skin distances. Injury 1998; 29: 297-299
• 62 Zengerink I, Brink PR, Laupland KB et al. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle?. J Trauma 2008; 64: 111-114
• 63 Deutsche Gesellschaft für Unfallchirurgie (Hrsg, federführend) et al. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. AWMF online http://www.awmf.org/uploads/tx_szleitlinien/012-019l_S3_Polytrauma_Schwerverletzten-Behandlung_2011-07_01.pdf zuletzt aufgerufen am 11. Juni 2012
• 64 Valenzuela TD, Kern KB, Clark LL et al. Interruptions of chest compressions during emergency medical systems resuscitation. Circulation 2005; 112: 1259-1265
• 65 Wik L, Kramer-Johansen J, Myklebust H et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 2005; 293: 299-304
• 66 Scieszka EL, Bogner V, Thun H et al. Evidenzbasierte Überlegungen zu Gefahren bei einer akzidentellen Defibrillation. Der Notarzt 2010; 26: 150-154