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Retinal Hemorrhage After Cardiopulmonary Resuscitation With Chest Compressions

Pham, Hang BS*; Enzenauer, Robert W. MD; Elder, James E. FRANZCO‡§; Levin, Alex V. MD, MHSc*∥

The American Journal of Forensic Medicine and Pathology: June 2013 - Volume 34 - Issue 2 - p 122–124
doi: 10.1097/PAF.0b013e31828c38f9
Case Reports

Retinal hemorrhages in children in the absence of risk factors are regarded to be pathognomonic of shaken baby syndrome or other nonaccidental injuries. The physician must decide whether the retinal hemorrhages in children without risk factors are due to abuse or cardiopulmonary resuscitation with chest compression (CPR-CC). The objective of this study was to determine if CPR-CC can lead to retinal hemorrhages in children. Twenty-two patients who received in-hospital CPR-CC between February 15, 1990, and June 15, 1990, were enrolled. Pediatric ophthalmology fellows carried a code beeper and responded to calls for cardiopulmonary arrest situations. At the scene of CPR-CC, an indirect funduscopic examination was conducted for presence of retinal hemorrhages in the posterior pole. Follow-up examinations were performed at 24 and 72 hours. Of the 22 patients, 6 (27%) had retinal hemorrhages at the time of CPR-CC. Of these 6 patients, 5 had risk factors for retinal hemorrhages. The sixth patient had no risk factors and may have represented the only true case of retinal hemorrhages due to CPR-CC. Retinal hemorrhages are uncommon findings after CPR-CC. Retinal hemorrhages that are found after CPR-CC usually occur in the presence of other risk factors for hemorrhage with a mild hemorrhagic retinopathy in the posterior pole.

From the *Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; †Department of Ophthalmology, Children’s Hospital Colorado, Aurora, CO; ‡Department of Ophthalmology, Royal Children’s Hospital, Victoria; §Department of Paediatrics, University of Melbourne, Melbourne, Australia; and ∥Pediatric Ophthalmology and Ocular Genetics, Wills Eye Institute, Philadelphia, PA.

Manuscript received December 22, 2011; accepted March 12, 2012.

The study was supported in part by the Foerderer Fund.

The authors report no conflicts of interest.

Reprints: Alex V. Levin, MD, MHSc, Wills Eye Institute, 840 Walnut St, Suite 1210, Philadelphia, PA 19107-5109. E-mail

© 2013 Lippincott Williams & Wilkins, Inc.