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Forensic Aspect of Cause of Subendocardial Hemorrhage in Cardiopulmonary Resuscitation Cases: Chest Compression or Adrenaline

Charaschaisri, Werasak MD*; Jongprasartsuk, Kesanee MD; Rungruanghiranya, Suthat MD; Kaufman, Larry MD§

The American Journal of Forensic Medicine and Pathology: March 2011 - Volume 32 - Issue 1 - p 58-60
doi: 10.1097/PAF.0b013e3181edee46
Original Articles

Subendocardial hemorrhage (SEH) is a striking feature seen in many forensic autopsy cases. It was believed earlier to represent an agonal phenomenon without any particular reference to the cause of death. However, the latest study showed that even minor SEH might have an influence on cardiac function and might be involved in the mechanism of death. To rule out the possible cause of SEH from defibrillation, autopsies were performed in 240 adults admitted to Department of Forensic Medicine, Faculty of Medicine, Srinakarinwirot University and Department of Forensic Medicine, Faculty of Medicine, Chulalongkorn University between July 2006 and June 2008. All the subjects were subdivided into 2 groups: one group receiving resuscitation and the other group receiving no resuscitation. In the former group, 76 patients had attempted cardiopulmonary resuscitation with adrenaline and 44 patients without adrenaline. While in the latter group, 120 patients received no resuscitation attempt. Approximately, 43.4% of resuscitation with adrenaline cases (33/76) demonstrated SEH in contrast to 4 cases of resuscitation without adrenaline (9.1%, P < 0.05). This demonstrates an increasing trend of SEH in cases with prolonged resuscitation and higher level of adrenaline utilizations.

From the *Faculty of Medicine, Srinakarinwirot, Ongkarak, Nakornnayok; †Department of Forensic Medicine, Faculty of Medicine, Chulalongkorn University; ‡Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand; and §Department of Medicine, University of Hawaii, Hilo, HI.

Manuscript received August 28, 2008; accepted May 27, 2009.

Correspondence: Werasak Charaschaisri, MD, BFM, Faculty of Medicine, Srinakharinwirot, Ongkarak, Nakornnayok 26120, Thailand. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.