Anatomical Injuries Following Cardiopulmonary Resuscitation: A Retrospective Evaluation in Autopsy Cases

Aim: This study aimed to evaluate the anatomical injuries resulting from cardiopulmonary resuscitation (CPR) at the system level in forensic autopsy cases and to investigate their association with variables such as CPR duration, age, and sex. Methods: A total of 121 cases, underw manual CPR and died from non-traumatic causes between February 2024 and March 2025, were included in the study. In all cases, injuries were systematically assessed across the skeletal system (rib and sternum fractures), cardiac structures (epicardial, endocardial, and pericardial hemorrhages), respiratory system, abdominal organs (liver, spleen, diaphragm), and major vessels. Results: Rib fractures were detected in 67.7% of the cases, and sternum fractures in 57.8%. Among those with sternum fractures, 93.3% also had concurrent rib fractures. Rib fractures were frequently bilateral, most commonly observed between the 3rd and 6th ribs, with a notable concentration at the bilateral 6th rib. Hemorrhages were identified in the epicardium (43.8%), endocardium (39.7%), and pericardium (45.5%) among cardiac structures. Injuries in the abdominal organs included the liver (37.2%), spleen (27.3%), and diaphragm (39.7%). A statistically significant positive correlation was found between CPR duration and the severity of cardiac and visceral injuries (p<0.001). Conclusions: CPR can lead to severe traumatic complications not only in the skeletal system but also in multiple organ systems. Particularly in prolonged resuscitation efforts, visceral structures appear to be substantially affected. Autopsy-based evaluations offer a comprehensive and reliable approach to identifying such injuries. The findings highlight the importance of assessing CPR-related complications from both forensic and clinical perspectives using a more holistic approach.