Cardiothoracic injuries after CardioPump CPR: a report of two cases and review of the literature

Abstract

Although many clinical trials have demonstrated its efficacy during active compression-decompression cardiopulmonary resuscitation (ACD-CPR), the Ambu® CardioPump seems likely to cause severe and sometimes lethal injuries. In this paper, we report two cases observed at the Institute of Legal Medicine of Nancy, France. A 67-year-old man collapsed in the street, in the presence of witnesses, and without any sign of trauma. The autopsy revealed a flail chest, a wound of the left ventricle, a rupture of the right ventricle, and a wrenching of the inferior vena cava. A 71-year-old woman was found in her apartment during an accidental fire. The autopsy revealed a sternal fracture, many rib fractures, and a perforation of the superior vena cava, the pericardium, and the heart. Despite articles focusing on complications of the use of the CardioPump in the late 1990s, this technique is still used in practice. These two cases emphasize that iatrogenic injuries must be taken into account in the CardioPump benefit/risk balance and the relevance of its daily use.

Severe Cardiac Rupture by Only One Blow to the Chest in a Young Boy: An Autopsy Case

“…Schultz and Trunkey proposed the following four mechanisms of BCI: direct precordial impact, crush injury resulting from compression between the sternum and spine, deceleration or torsion causing a tear in the heart at a point of fixation, and a hydraulic effect resulting in rupture, such as sudden abdominal compression that results in significantly elevated venous pressure that is transmitted to the right atrium. Although some previous reports have described CPR‐associated cardiac injuries, especially those caused by active compression–decompression CPR , most such injuries were relatively mild (e.g., pericardial injuries). We do not believe that CPR caused the cardiac rupture in the present case because the location and appearance of the right ventricular rupture was very typical for that seen with high‐energy impact injuries of the lower chest, such as those commonly seen in motor vehicle accidents; such rupture is rarely seen in the setting of aggressive CPR.…”

Injuries after cardiopulmonary resuscitation in the pre-hospital and hospital care in two regions of the Czech Republic: retrospective observational cohort study

“…The positive effect of CP compared to manual CC is controversial and the use of the device is not mentioned in the European Resuscitation Guidelines 2021 [12]. Serious iatrogenic damage to the patient, that can also be potentiated by the patient's age, have been reported [13,14]. The devices for mechanical chest compressions are used more often than CP and other studies also reported higher frequency of chest injuries after using the LUCAS ® 2 device in pre-hospital emergency care (e. g. 72.7%) [15].…”

Subacute Aortic Rupture Due to Mechanical Chest Compression with Indwelling Impella

“…Biventricular rupture plus complete tear of the inferior vena cava with an active compression-decompression CPR was described by Kolopp et al 3 Many injuries go undetected until autopsy as reflected by the body of literature in forensic journals.…”