Post-cardiopulmonary resuscitation trauma: retrospective analysis of skeletal and visceral injuries in autopsy findings

Forensic Sci Med Pathol. 2025 Sep;21(3):1222-1229. doi: 10.1007/s12024-025-01028-1. Epub 2025 Jun 2.

Abstract

This study evaluates skeletal and visceral injuries associated with CPR, providing insights for clinicians and forensic experts. A retrospective analysis of 520 autopsy cases, selected from 2,508 conducted between 2021 and 2022 in Türkiye, was performed. Inclusion criteria focused on cases receiving CPR post-cardiac arrest, excluding pre-existing thoracic or abdominal trauma. Data were analyzed for demographic variables, injury types, and correlations with age, gender, and body mass index (BMI). Rib fractures were identified in 56.7% of cases, with a median of 9 fractures. Sternum fractures occurred in 42.9%, more frequently in females (55.4% vs. 38.7%; OR = 2.36, 95% CI = 1.50-3.74) and older individuals. Rib fractures were associated with age and BMI, whereas sternum fractures correlated with age and female gender. Lung (13.5%) and cardiac (5.4%) contusions were the most common. Younger individuals (0-17 years) showed fewer skeletal injuries but higher rates of isolated visceral trauma. Skeletal injuries were prevalent in individuals > 50 years, whereas visceral injuries were more common in younger cases. CPR-related injuries exhibit significant variation across demographics. Awareness of these patterns is vital for improving resuscitation protocols and post-CPR evaluations, potentially minimizing trauma.

Keywords: Autopsy; Cardiopulmonary resuscitation; Chest compression; Forensic medicine; Post-CPR injuries.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Autopsy
  • Body Mass Index
  • Cardiopulmonary Resuscitation* / adverse effects
  • Child
  • Child, Preschool
  • Female
  • Fractures, Bone / epidemiology
  • Fractures, Bone / pathology
  • Heart Arrest / therapy
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rib Fractures / epidemiology
  • Rib Fractures / pathology
  • Sex Distribution
  • Sternum / injuries
  • Sternum / pathology
  • Turkey / epidemiology
  • Young Adult