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Two-Handed Cardiopulmonary Resuscitation Can Cause Rib Fractures in Infants

Matshes, Evan W. MD, FRCPC*; Lew, Emma O. MD†

American Journal of Forensic Medicine & Pathology: December 2010 - Volume 31 - Issue 4 - pp 303-307
doi: 10.1097/PAF.0b013e3181e792eb
Original Articles

The discovery of acute rib fractures in deceased infants and young children can be unsettling. Although significant injuries may occur subsequent to resuscitative efforts in adults, it is well documented that such injuries are rare in much younger individuals. In particular, it is considered exceptional for rib fractures to follow cardiopulmonary resuscitation (CPR) on an infant; thus, some pathologists will consider such a discovery to be evidence of abuse. However, little is known about what, if any, injuries might occur subsequent to the delivery of "2-handed" CPR. Five unrelated, nonsequential cases of infant death are reported where multiple acute anterolateral rib arc fractures followed 2-handed CPR delivered by trained medical personnel.

From the *Alberta Office of the Chief Medical Examiner, Calgary, Alberta, Canada; and †Miami-Dade County Medical Examiner Department, Miami, FL.

Manuscript received November 3, 2009; accepted May 7, 2010.

Correspondence: Evan W. Matshes, MD, FRCPC, Alberta Office of the Chief Medical Examiner, 4070 Bowness Road, Calgary, Alberta T3B 3R7, Canada. E-mail: matshes@deathinvestigator.com.

© 2010 Lippincott Williams & Wilkins, Inc.