An Autopsy Case of Air Embolism as a CPR Artefacts

Lee, Ho; Lee, Bong Woo; Hur, Dae Young; Seo, Joong Seok

Abstract

We report on a case of amniotic fluid embolism with air embolism during the labor of multigravida. The patient complained about sudden dyspnea during labor. She turned pale, got disturbed and broke out in a cold sweat. Blood pressure was unmeasurable; peripheral pulse could not be felt. Immediately intensive CPR was performed. The condition of the patient got worse after a short time of improvement. The patient died after about 9 hours. Amniotic fluid contents could be found in the victim 's pulmonary microvasculature. The cause of death was ruled as an amniotic fluid embolism. However, Air embolism was detected during the autopsy. We considered that postmortem air embolism was produced by external cardiac compression. External cardiac compression (ECC) with respiratory care is usually done during emergency conditions. However, ECC produce many artefacts such as sternal or rib fracture, direct cardiac injury, pulmonary injury, fat embolism, liver injury so on. Air embolism is rare artefact. The mechanism of air passing from the venous to systemic circulation in our case remains speculative. However, intense ECC itself with its underlying thoracic pump mechanism has to be considered as contributing to the transport of air from the venous to the arterial side of circulation. In situation of CPR was performed, It must be differentiated from the antemortem air embolism by thorough history taking.