Manual and automated cardiopulmonary resuscitation (CPR): a comparison of associated injury patterns

J Forensic Sci. 2013 Jul;58(4):904-9. doi: 10.1111/1556-4029.12146. Epub 2013 May 21.


The purpose of this study was to identify and compare patterns of trauma associated with AutoPulse(®) CPR and manual CPR. Finalized autopsy records from 175 decedents brought to the Harris County Institute of Forensic Sciences were reviewed, 87 received manual-only CPR, and 88 received AutoPulse(®) CPR (in combination with manual CPR as per standard protocol). The characteristic pattern observed in manual-only CPR use included a high frequency of anterior rib fractures, sternal fractures, and midline chest abrasions along the sternum. The characteristic pattern observed in AutoPulse(®) CPR use included a high frequency of posterior rib fractures, skin abrasions located along the anterolateral chest and shoulder, vertebral fractures, and a few cases of visceral injuries including liver lacerations, splenic lacerations, and hemoperitoneum. Knowledge of the AutoPulse(®) CPR injury pattern can help forensic pathologists differentiate therapeutic from inflicted injuries and therefore avoid an erroneous assessment of cause and manner of death.

Keywords: AutoPulse®; cardiopulmonary resuscitation; device-assisted cardiopulmonary resuscitation; forensic pathology; forensic science; trauma.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Cardiopulmonary Resuscitation / adverse effects*
  • Cardiopulmonary Resuscitation / methods*
  • Female
  • Forensic Pathology
  • Fractures, Bone / pathology
  • Hemoperitoneum / pathology
  • Humans
  • Liver / injuries
  • Liver / pathology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rib Fractures / pathology
  • Skin / injuries
  • Skin / pathology
  • Spinal Fractures / pathology
  • Spleen / injuries
  • Spleen / pathology
  • Sternum / injuries
  • Sternum / pathology
  • Thorax
  • Young Adult