Risk of myocardial contusion in cardiac arrest patients resuscitated with mechanical chest compression device
Abstract
We prospectively collected relevant medical history and hospitalization data of all consecutive cardiac arrest patients resuscitated with mCCD at our Department of Cardiology from June 2012 to August 2013. LUCAS 2 (Medtronic, Minneapolis, MN, USA) was used for mechanical chest compressions.
It is a cardiopulmonary resuscitation (CPR) device providing automatic 5 cm deep compressions and active decompressions with a frequency of 100 per minute. In patients who did not survive to hospital discharge an autopsy was requested.
We specifically looked for macroscopic and microscopic signs of myocardial contusion. Cardiac contusion is a well-defined entity with distinct pathologic abnormalities including patchy necrosis, edema and substantial hemorrhage in a pyramidal fashion and distinct boundary between normal and contused tissue whereas in the myocardial infarction there is generalized coagulation necrosis and gradual transition from the infarcted to the normal tissue [5].
Macroscopically superficial areas of epicardial hemorrhage are seen which extend in a pyramidal fashion intramurally [6]. At least four histologic samples of myocardium were taken from anterior, posterior and lateral wall of left ventricle and from interventricular septum.
In patients with acute myocardial infarction samples from sites of myocardial necrosis due to ischemic heart injury were excluded. A retrospective control group was created from medical records, autopsy reports and available myocardial tissue samples of patients resuscitated without use of any mCCD (manualCC group) who died at the same department during the study period.