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Thach R, Cina A, Gitto L. Fatal bone marrow embolism. Proc AMIA Symp 2022; 35:714-716. [DOI: 10.1080/08998280.2022.2081953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Rasmey Thach
- William Beaumont Army Medical Center, Fort Bliss, Texas
| | - Alexandra Cina
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas
| | - Lorenzo Gitto
- Department of Pathology and Laboratory Medicine, SUNY Upstate Medical University, Syracuse, New York
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Ondruschka B, Baier C, Bernhard M, Buschmann C, Dreßler J, Schlote J, Zwirner J, Hammer N. Frequency and intensity of pulmonary bone marrow and fat embolism due to manual or automated chest compressions during cardiopulmonary resuscitation. Forensic Sci Med Pathol 2018; 15:48-55. [PMID: 30443888 DOI: 10.1007/s12024-018-0044-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 11/27/2022]
Abstract
Iatrogenic consequences of cardiopulmonary resuscitation (CPR) include sternal or rib fractures, pulmonary bone marrow embolisms (BME) and fat embolisms (FE). This report aimed to analyze the frequency and intensity of pulmonary BME and FE in fatal cases receiving final CPR efforts with the use of automated chest compression devices (ACCD) or manual chest compressions (mCC). The study cohort (all cardiac causes of death, no ante-mortem fractures) consisted of 15 cases for each group 'ACCD', 'mCC' and 'no CPR'. Lung tissue samples were retrieved and stained with hematoxylin eosin (n = 4 each) and Sudan III (n = 2 each). Evaluation was conducted microscopically for any existence of BME or FE, the frequency of BME-positive vessels, vessel size for BME and the graduation according to Falzi for FE. The data were compared statistically using non-parametric analyses. All groups were matched except for CPR duration (ACCD > mCC) but this time interval was linked to the existence of pulmonary BME (p = 0.031). Both entities occur in less than 25% of all cases following unsuccessful CPR. BME was only detectable in CPR cases, but was similar between ACCD and mCC cases for BME frequency (p = 0.666), BME intensity (p = 0.857) and the size of BME-affected pulmonary vessels (p = 0.075). If any, only mild pulmonary FE (grade I) was diagnosed without differences in the CPR method (p = 0.624). There was a significant correlation between existence of BME and FE (p = 0.043). Given the frequency, intensity and size of pulmonary BME and FE following CPR, these conditions may unlikely be considered as causative for death in case of initial survival but can be found in lower frequencies in autopsy histology.
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Affiliation(s)
- Benjamin Ondruschka
- Institute of Legal Medicine, University of Leipzig, Johannisallee 28, D-04103, Leipzig, Germany.
| | - Christina Baier
- Institute of Legal Medicine, University of Leipzig, Johannisallee 28, D-04103, Leipzig, Germany
| | - Michael Bernhard
- University Hospital, Emergency Department, Heinrich Heine University, Duesseldorf, Germany
| | - Claas Buschmann
- Institute of Legal Medicine, Charité-Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan Dreßler
- Institute of Legal Medicine, University of Leipzig, Johannisallee 28, D-04103, Leipzig, Germany
| | - Julia Schlote
- Institute of Legal Medicine, University of Leipzig, Johannisallee 28, D-04103, Leipzig, Germany
| | - Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Department of Orthopedic and Trauma Surgery, University Hospital of Leipzig, Leipzig, Germany
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
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Fulminant Cerebral Fat Embolism: Case Description and Review of the Literature. Case Rep Crit Care 2018; 2018:7813175. [PMID: 30105101 PMCID: PMC6076907 DOI: 10.1155/2018/7813175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/26/2018] [Indexed: 12/03/2022] Open
Abstract
The release of fat and bone marrow fragments is a common occurrence following traumatic and nontraumatic events. In most cases, they go symptomless or cause only minor disturbances, but occasionally they can determine a multiorgan dysfunction whose severity ranges from mild to fatal. The authors describe the case of a patient who became deeply comatose and ultimately died after a traffic accident in which he suffered the exposed right femoral and tibial fracture in the absence of other injuries. He underwent the external fixation of the fractured bones 2 hours after the admission under general anesthesia. Three hours later, he failed to awake at the suspension of the anesthetic agents and became anisocoric; a CT scan demonstrated a diffuse cerebral edema with the herniation of the cerebellar tonsils; these abnormalities were unresponsive to the treatment and the brain death was one day later. The causes, the mechanisms, the symptoms, the prevention, and the treatment of the syndrome are reviewed and discussed.
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Sinicina I, Pankratz H, Schöpfer J. Ungewöhnliche Fälle von pulmonaler Embolie. Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0219-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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