[Sudden cardiac death. Selected forensic aspects]

Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human

INTRODUCTION

Cardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest.

METHODS AND ANALYSIS

A sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I²-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

ETHICS AND DISSEMINATION

No ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences.

PROSPERO REGISTRATION NUMBER

CRD42017051633.

Fulminant myocarditis as a primary manifestation of H1N1 infection: A first reported case from Serbia

A 19-year-old male was admitted to our clinic with a diagnosis of suspected acute pericarditis and acute coronary syndrome. The initial diagnostics at our clinic revealed fulminant myocarditis. Twenty-four hours after admission, the patient's condition deteriorated, and he required mechanical ventilation and cardiopulmonary resuscitation. Unfortunately, the patient died. Clinical course, postmortem pathohistological findings and virus serology indicated that an H1N1 viral caused fulminant myocarditis and was the primary manifestation.

Sudden death of a middle aged woman with a series of undiagnosed gynaecologic diseases

Gynaecologic diseases unrelated to pregnancy are not generally associated with sudden death, which limits the number of case reports published in the field of forensic medicine. Presented in this paper is a fatal case in a middle aged woman with an early stage endometrial cancer and a series of gynaecologic diseases, in whom such typical features of sudden death were not applicable. Forensic autopsy revealed the hypoplasia of left circumflex coronary artery, Stage 1B endometrial cancer, endometriosis, polycystic ovary syndrome (PCOS) and micro pituitary adenoma, whereas histochemical analyses confirmed hyperprolactinemia and hyperestradiolemia. It was considered that the hypoplasia of coronary artery, chronic anaemia and electrolyte imbalance due to endometrial cancer all collaborated to induce acute cardiac failure. The association between prolactinoma, PCOS and endometrial cancer was also suggested, though they are rarely observed synchronously. It was speculated that the deceased had been anaemic for a substantial period of time and lacked clear subjective symptoms, which made the antemortem diagnosis of her underlying diseases difficult. Forensic pathologists must always consider the possibility of gynaecologic diseases taking significant part in a fatal cause of reproductive-aged women.