Findings Related to Attempted Cardiopulmonary Resuscitation on Post Mortem Computed Tomography

Few studies have compared the sensitivities of autopsy and post mortem computed tomography (PMCT) in detecting rib fractures caused by cardiopulmonary resuscitation (CPR). We aimed to compare the characteristics between both modalities for accurately detecting CPR-related rib fractures. This single-centre observational study included adult patients with autopsy records and PMCT scans at our institution from January 2013 to March 2019. CPR-related rib fractures were evaluated using autopsy and PMCT findings. In 62 patients enrolled, 339 rib fractures were detected on autopsy and/or PMCT (222 fractures on both PMCT and autopsy, 69 on PMCT alone, and 50 on autopsy alone). The agreement of detection for both modalities was substantial (kappa coefficient, 0.78). In the logistic regression model, incomplete fractures detected by PMCT and age <75 years were significantly associated with findings that were negative on autopsy but positive on PMCT, while rib number (ribs 1–3 and 7–12) and fracture location (posterolateral and paravertebral) were significantly associated with negative PMCT findings but positive autopsy findings. Autopsy and PMCT showed complementary roles, and are thus necessary in accurately detecting CPR-related rib fractures. Combining both modalities may contribute to improved CPR quality and better understanding of discrepancy in characteristics between the two modalities.

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Could post-mortem computed tomography angiography inform cardiopulmonary resuscitation research?

Resuscitation ◽

10.1016/j.resuscitation.2017.09.022 ◽

2017 ◽

Vol 121 ◽

pp. 34-40 ◽

Cited By ~ 6

Author(s):

Guy N. Rutty ◽

Claire Robinson ◽

Jasmin Amoroso ◽

Tim Coats ◽

Bruno Morgan

Keyword(s):

Computed Tomography ◽

Cardiopulmonary Resuscitation ◽

Computed Tomography Angiography ◽

Post Mortem

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Findings in post mortem computed tomography (PMCT) after cardiac surgery of the adult

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332724 ◽

2013 ◽

Vol 61 (S 01) ◽

Author(s):

B Vogel ◽

H Gulbins ◽

H Reichenspurner ◽

A Heinemann ◽

H Vogel

Keyword(s):

Computed Tomography ◽

Cardiac Surgery ◽

Post Mortem

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Transcatheter aortic valve implantation in post mortem computed tomography

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332717 ◽

2013 ◽

Vol 61 (S 01) ◽

Author(s):

B Vogel ◽

H Gulbins ◽

H Reichenspurner ◽

A Heinemann ◽

H Vogel

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Post Mortem ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Congenital heart malformation of new born in post mortem computed tomography

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332386 ◽

2013 ◽

Vol 61 (S 01) ◽

Author(s):

B Vogel ◽

H Gulbins ◽

H Reichenspurner ◽

A Heinemann ◽

H Vogel

Keyword(s):

Computed Tomography ◽

Congenital Heart ◽

Post Mortem ◽

New Born ◽

Heart Malformation

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Computed Tomography Imaging in Simulated Ongoing Cardiopulmonary Resuscitation: No Need to Switch Off the Chest Compression Device during Image Acquisition

Diagnostics ◽

10.3390/diagnostics11061122 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1122

Author(s):

Jessica Graef ◽

Bernd A. Leidel ◽

Keno K. Bressem ◽

Janis L. Vahldiek ◽

Bernd Hamm ◽

...

Keyword(s):

Computed Tomography ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Image Acquisition ◽

Circulatory Arrest ◽

Motion Artifacts ◽

Current Standard ◽

Ct Protocol ◽

Life Threatening ◽

Reconstruction Time

Computed tomography (CT) represents the current standard for imaging of patients with acute life-threatening diseases. As some patients present with circulatory arrest, they require cardiopulmonary resuscitation. Automated chest compression devices are used to continue resuscitation during CT examinations, but tend to cause motion artifacts degrading diagnostic evaluation of the chest. The aim was to investigate and evaluate a CT protocol for motion-free imaging of thoracic structures during ongoing mechanical resuscitation. The standard CT trauma protocol and a CT protocol with ECG triggering using a simulated ECG were applied in an experimental setup to examine a compressible thorax phantom during resuscitation with two different compression devices. Twenty-eight phantom examinations were performed, 14 with AutoPulse® and 14 with corpuls cpr®. With each device, seven CT examinations were carried out with ECG triggering and seven without. Image quality improved significantly applying the ECG-triggered protocol (p < 0.001), which allowed almost artifact-free chest evaluation. With the investigated protocol, radiation exposure was 5.09% higher (15.51 mSv vs. 14.76 mSv), and average reconstruction time of CT scans increased from 45 to 76 s. Image acquisition using the proposed CT protocol prevents thoracic motion artifacts and facilitates diagnosis of acute life-threatening conditions during continuous automated chest compression.

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Scopolamine fatal outcome in an inmate after buscopan® smoking

International Journal of Legal Medicine ◽

10.1007/s00414-021-02583-2 ◽

2021 ◽

Author(s):

Sabina Strano-Rossi ◽

Serena Mestria ◽

Giorgio Bolino ◽

Matteo Polacco ◽

Simone Grassi ◽

...

Keyword(s):

Computed Tomography ◽

Drug Abuse ◽

Muscarinic Receptors ◽

Histopathological Examination ◽

Fatal Outcome ◽

Post Mortem ◽

Butyl Bromide ◽

Cannabis Abuse ◽

Toxic Concentration ◽

History Of

AbstractScopolamine is an alkaloid which acts as competitive antagonists to acetylcholine at central and peripheral muscarinic receptors. We report the case of a 41-year-old male convict with a 27-year history of cannabis abuse who suddenly died in the bed of his cell after having smoked buscopan® tablets. Since both abuse of substances and recent physical assaults had been reported, we opted for a comprehensive approach (post-mortem computed tomography CT (PMCT), full forensic autopsy, and toxicology testing) to determine which was the cause of the death. Virtopsy found significant cerebral edema and lungs edema that were confirmed at the autopsy and at the histopathological examination. Scopolamine was detected in peripheral blood at the toxic concentration of 14 ng/mL in blood and at 263 ng/mL in urine, and scopolamine butyl bromide at 17 ng/mL in blood and 90 ng/mL in urine. Quetiapine, mirtazapine, lorazepam, diazepam, and metabolites and valproate were also detected (at therapeutic concentrations). Inmates, especially when they have a history of drug abuse, are at risk to use any substance they can find for recreational purposes. In prisons, active surveillance on the management and assumption of prescribed drugs could avoid fatal acute intoxication.

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Error estimation on extracorporeal trajectory determination from body scans

International Journal of Legal Medicine ◽

10.1007/s00414-021-02676-y ◽

2021 ◽

Author(s):

F. Riva ◽

U. Buck ◽

K. Buße ◽

R. Hermsen ◽

E. J. A. T. Mattijssen ◽

...

Keyword(s):

Computed Tomography ◽

Soft Tissue ◽

Supine Position ◽

Post Mortem ◽

Surface Scanning ◽

3D Data ◽

Gravitational Pull ◽

Scanned Images ◽

Source Of Error ◽

Trajectory Determination

AbstractThis study explores the magnitude of two sources of error that are introduced when extracorporeal bullet trajectories are based on post-mortem computed tomography (PMCT) and/or surface scanning of a body. The first source of error is caused by an altered gravitational pull on soft tissue, which is introduced when a body is scanned in another position than it had when hit. The second source of error is introduced when scanned images are translated into a virtual representation of the victim’s body. To study the combined magnitude of these errors, virtual shooting trajectories with known vertical angles through five “victims” (live test persons) were simulated. The positions of the simulated wounds on the bodies were marked, with the victims in upright positions. Next, the victims were scanned in supine position, using 3D surface scanning, similar to a body’s position when scanned during a PMCT. Seven experts, used to working with 3D data, were asked to determine the bullet trajectories based on the virtual representations of the bodies. The errors between the known and determined trajectories were analysed and discussed. The results of this study give a feel for the magnitude of the introduced errors and can be used to reconstruct actual shooting incidents using PMCT data.

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Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems

Virchows Archiv ◽

10.1007/s00428-020-02934-1 ◽

2020 ◽

Cited By ~ 3

Author(s):

Emanuela Barisione ◽

Federica Grillo ◽

Lorenzo Ball ◽

Rita Bianchi ◽

Marco Grosso ◽

...

Keyword(s):

Computed Tomography ◽

Diffuse Alveolar Damage ◽

Ground Glass Opacity ◽

Post Mortem ◽

Mechanically Ventilated ◽

Illness Duration ◽

Transbronchial Lung Cryobiopsy ◽

Histopathologic Analysis ◽

Lung Lobes

Abstract Data on the pathology of COVID-19 are scarce; available studies show diffuse alveolar damage; however, there is scarce information on the chronologic evolution of COVID-19 lung lesions. The primary aim of the study is to describe the chronology of lung pathologic changes in COVID-19 by using a post-mortem transbronchial lung cryobiopsy approach. Our secondary aim is to correlate the histologic findings with computed tomography patterns. SARS-CoV-2-positive patients, who died while intubated and mechanically ventilated, were enrolled. The procedure was performed 30 min after death, and all lung lobes sampled. Histopathologic analysis was performed on thirty-nine adequate samples from eight patients: two patients (illness duration < 14 days) showed early/exudative phase diffuse alveolar damage, while the remaining 6 patients (median illness duration—32 days) showed progressive histologic patterns (3 with mid/proliferative phase; 3 with late/fibrotic phase diffuse alveolar damage, one of which with honeycombing). Immunohistochemistry for SARS-CoV-2 nucleocapsid protein was positive predominantly in early-phase lesions. Histologic patterns and tomography categories were correlated: early/exudative phase was associated with ground-glass opacity, mid/proliferative lesions with crazy paving, while late/fibrous phase correlated with the consolidation pattern, more frequently seen in the lower/middle lobes. This study uses an innovative cryobiopsy approach for the post-mortem sampling of lung tissues from COVID-19 patients demonstrating the progression of fibrosis in time and correlation with computed tomography features. These findings may prove to be useful in the correct staging of disease, and this could have implications for treatment and patient follow-up.

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