Document Detail

Relationship between cardiopulmonary resuscitation and injuries of the cardiac conduction system: pathological features and pathogenesis of such injuries.
MedLine Citation:
PMID:  16424715     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The purpose of this study was to assess the incidence, features, and pathogenesis of microscopic injuries to the cardiac conduction system caused by cardiopulmonary resuscitation. DESIGN:: Prospective study. SETTING: Autopsy unit of the university. PATIENTS: Victims who had been transferred to the emergency room due to cardiac arrest arising from nontraumatic cause plus age-matched control patients. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: The cardiac conduction system of 80 hearts without gross injury from patients who had received cardiopulmonary resuscitation due to nontraumatic causes was examined. Of these 80 patients, seven (9%) showed fresh injuries, including a lesion that had gone unreported in the previous literature. Localized hemorrhage without inflammatory reaction was evident in six of these patients. Three of the six patients showed hemorrhage in the sinoatrial node, whereas the other three patients showed hemorrhage in the atrioventricular conduction system. The remaining one patient showed localized dissection of the atrioventricular node artery with the appearance of red blood cells in the false lumen. There was no significant difference with regard to age, gender, cause of cardiopulmonary arrest, whether victim had received electrical shock treatment, whether victim had received anticoagulants, and the duration of cardiopulmonary resuscitation between the seven patients with fresh injuries and the other 73 patients. Fracture of the sternum or rib was found in only one of the seven patients but in 14 of the 73 patients. No pathologic lesions were found in the 30 control patients who did not receive cardiopulmonary resuscitation. CONCLUSIONS: It can be presumed that injuries to the conduction system do occur in limited regions during cardiopulmonary resuscitation. Minute differences in the location of the cardiac silhouette or cardiac conduction system also need to be considered, rather than just the severity of force to the anterior chest, when determining the pathogenesis of these injuries.
Naoki Nishida; Takashi Chiba; Maki Ohtani; Noriaki Ikeda; Yosei Katayama; Naofumi Yoshioka
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  34     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-20     Completed Date:  2006-02-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  363-7     Citation Subset:  AIM; IM    
Department of Forensic Science, Akita University School of Medicine, Akita, Japan.
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MeSH Terms
Aged, 80 and over
Cardiopulmonary Resuscitation / adverse effects*
Case-Control Studies
Cause of Death*
Heart Arrest / therapy*
Heart Conduction System / injuries*,  pathology
Middle Aged
Comment In:
Crit Care Med. 2006 Feb;34(2):554-5   [PMID:  16424747 ]

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