JORNAL READING

Life-Threatening and
Suspicious Lesions
Caused by
Mechanical
Cardiopulmonary
Resuscitation

Yolanda Satriani Putri (H1A013063)

Jurnal Identity
Titled : Life-Threatening and
Suspicious Lesions Caused by Mechanical
Cardiopulmonary Resuscitation
Author : Louise Milling, Peter Mygid
Publisher : Am J Forensic Med Pathol
Publish Year : 2017
Volume : 00
Number : 00
Page : 1-3
Type of Journal : Case Report
Keyword of The Journal
Autopsy,
Cardiopulmonary resuscitation
Thoracic injuries
Abdominal
Injuries
Lucas2
Introduction
Chest compression devices for mechanical
CPR have become more common. Here, we
report the case of a young woman who
attempted resuscitated with LUCAS2 ( a
device) after she was found unconscious at
home.
At autopsy, we found extensive intramuscular
hemorrhages in posterior neck, between the
scapulae, and in the lumbar region.
Investigation of internal organs showed injuries
to the lung, spleen, and kidney.
Introduction
The extension of the injuries gave rise to
suspicion of homicide by smothering, which
police investigation subsequently did not
support. The pattern of injury could be
attributed to automatic compression
decompression CPR with LUCAS2.

For the forensic pathologists, it is important to

remain updated on developments in
treatment techniques to avoid pitfalls when
interpreting injury.
Case Report
A 20-year-oldwoman was found unconscious
at home in bed by her former boyfriend. He
called emergency services and began CPR.
The emergency team arrived 15 minutes later
and initiated CPR with intubation and
mechanical chest compressions with a piston
drive device (LUCAS)
The woman was declared dead after 20
minutes of unsuccessful CPR
Case Report
However, the police found the
unexplained death of such a young and
previously healthy woman suspicious and
ordered a forensic autopsy.
There were no signs of forced entry or a
struggle at the scene.
AUTOPSY RESULT
The forensic pathologist noted bruising on the
posterior aspect of the neck and small
abrasions and bruising around the mouth.
Dissection of the back revealed symmetric
areas of hemorrhage in the lumbar region
and between the scapulae
Investigation of the internal organs disclosed
a 7-cm long and deep laceration at the root
of the upper lobe of the right lung and a 5-
cm long and deep laceration of the spleen,
but without signs of recent or significant
bleeding.
AUTOPSY RESULT
There was a small laceration of the right
kidney and a few small hemorrhages
involving the intestines. No rib fractures, hyoid
bone, or upper thyroid horn fractures or other
lesions were found at autopsy or on a
postmortem CT performed before autopsy.
The autopsy showed slight cerebral edema,
moderate lung edema, and shock kidneys,
but the internal organs were otherwise normal
and without pathology.
AUTOPSY RESULT
Histology of tissue samples from the neck and
internal organs confirmed the findings of
cerebral and pulmonary edema and that the
muscle bleeding was fresh but disclosed no
other pathology.
Forensic toxicology screening was negative.
Samples were secured for genetic testing, but
this was not performed as the deceased had
no close relatives.
Cause of death
The cause of death could not be determined.
The forensic pathologist deemed the bruising
on the back of the neck and around the
mouth suspicious for smothering but had no
explanation for the internal lesions or
intramuscular hemorrhages.
Police investigation confirmed the alibi of the
former boyfriend. Interrogation of the
emergency rescue team revealed that a
mechanical chest compression device,
LUCAS2.
Cause Of Death
This is a piston device driven by gas, providing
mechanical compression and active
decompression at a default frequency of 100
cycles per minute with a maximum depth of
52 mm. It consists of a silicon suction cup and
a pneumatic cylinder mounted on 2 legs
attached to a stiff back plate. A stabilization
strap attaches around the neck, preventing
the machine from moving.
After this information became available, it
was deemed possible that all lesions may
have arisen due to the resuscitation.
Discussion
 Mechanical chest compression device can
result in lesions that may have been lethal
It is well known and often reported in the
literature that CPR may cause
intra-abdominal injuries include gastric rupture
and solid organ disruption,
lung lacerations because of compression force
itselfor stabbing by the tips of broken ribs
Splenic lacerations
Hepatic lacerations
 We noted extensive bleeding in the
musculature of the neck and back. To our
knowledge, the present case is the first
description of intramuscular hemorrhages
sustained during automatic compression
decompression (ACD) CPR with a LUCAS2.
The bruising in the neck region was likely
caused by the stabilization strap, and
administration of efficient mechanical chest
compressions seems to explain the
aforementioned muscular hemorrhages.
Conclusion
The police investigation clarified the order
of events, and according to this
investigation, itwas considered highly
unlikely that a criminal act occurred. Thus,
the most probable explanation for the
death of the young woman was death
from natural causes, for instance, occult
cardiac disease.
conclusiom
The pattern of injury was extensive, with relatively
large intramuscular hemorrhages on the neck and
back. The injuries may be attributed to ACD-CPR with
a LUCAS2.
This pattern of injury has not previously been
described in the literature. For forensic pathologists, it
is important to remain updated on developments in
treatment techniques to avoid pitfalls when
interpreting injury.
Furthermore, it is crucial for forensic pathologists to
add to the accumulated knowledge regarding new
therapeutic strategies when necessary. Larger
studies, prospective or retrospective, may be able to
qualify the possible risks of ACD-CPR even further.
 Advantages Disadvantage
The Title was Not mention the
interesting enough citation on same
Abstact was simple statement
and clear
Mention all the
finding in autopsy
Mention the next
step