Cardiopulmonary Resuscitation and Direct Cardiac Injury: Evidence of Fractured Coronary Arteries and HIS Bundle Hemorrhage.

The heart is believed to escape serious direct injury during the administration of closed chest cardiopulmonary resuscitation (CPR). However, no comprehensive histologic studies of the coronary arteries or the atrioventricular conduction system have been performed to determine whether these structures might be injured by CPR. This report includes a retrospective review of 105 human hearts extensively studied at autopsy after the injection of a colored barium gelatin mass into the coronary arteries. The study group, 83 males and 22 females, included 63 patients (60%) who died in the hospital. Eighty patients (76%) received CPR immediately prior to death. Evidence consistent with direct blunt injury to the coronary arteries and/or the His Bundle was found in 35 (44%) patients who received CPR. These structural changes were characterized by fracture and disruption of the coronary artery wall and/or hemorrhage into the region of the branching His Bundle. Females were significantly older and showed a significantly higher frequency of these lesions than males. Injuries were not related to the site where CPR was administered, in- or out-of-hospital, nor to the duration of CPR. We conclude that CPR is associated with evidence of direct blunt injury to the coronary arteries and/or the His Bundle and proximal bundle branches; and that these lesions may influence the outcome of resuscitative efforts as well as ultimate prognosis.