Abstract
Purpose: It is difficult to investigate the cause of unexpected death by autopsy in regions where there is no medical examiner system like Nobeoka City. This study evaluated the efficacy of the findings obtained from postmortem whole body computed tomography (PMCT) in addition to clinical examinations of out-of-hospital cardiopulmonary arrest (OHCPA) cases for identification of the causes of OHCPA and complications associated with cardiopulmonary resuscitation (CPR).
Subjects & Methods: The subjects were 180 cases out of 222 non-traumatic OHCPA cases between January 1, 2009 and December 31, 2011 (male/female 99/81, age 0-100 years: mean 74.4 years), who underwent PMCT due to unknown causes. The aim was to detect the cause of death and identify complications due to CPR (rib fractures, sternum fractures, and pneumothorax) with postmortem clinical examinations (prodromes, past history, physical findings, laboratory results) and the findings of PMCT. The study compared the confirmed causes of deaths with previously published data of postmortem autopsy in Kobe.
Results: The confirmed causes of deaths were cardiac disorders (ischemic and others) in 8.9% of patients, cerebrovascular disorders (subarachnoid hemorrhage etc.) in 8.9%, aortic disorders (aortic aneurysmal rupture etc) in 12.2%, respiratory disorders in 13.3%, aspiration/asphyxiation in 3.9%, and unknown causes in 41.1%. A comparison with the data from Kobe revealed that the ratio of cardiac disorders was lower (8.9 vs. 44.7%) and that of unknown causes was higher (41.1 vs. 4.7%), and the amplitude between them was almost same (35.8 vs. 36.4%). Compared with the results by autopsy, cardiac disorders (ischemic and others) could not be sufficiently confirmed by the PMCT findings. There was little difference between the ratio of cerebrovascular, aortic, respiratory and digestive-pelvic disorders. The ratio of confirmed causes of death by the findings of PMCT alone was 32.2%, most of which were cerebrovascular and aortic disorders, and by those of combined clinical examinations and PMCT was 26.7%, which included aspiration/asphyxiation, respiratory disorders and digestive-pelvic disorders, the total ratio resulting in 58.9%. The ratio of events associated with CPR was pneumothorax in 6.3%, rib fractures in 14.9%, and sternum fractures in 4.5%.
Conclusion: The PMCT findings could be helpful for the investigation of causes of death in the non-traumatic OHCPA cases due to unknown causes and the detection of CPR, especially chest compression, related complications in the region where no exploratory autopsy was available.
