A Prospective, Autopsy Based Study of Spectrum, Patterns, and Medicolegal Implications of Resuscitation Induced Iatrogenic Artefacts

Abstract

Background: In present days, intensive care and emergency medical procedures frequently leave behind unique physical marks on the hospitalized patients. In this, cardiopulmonary resuscitation (CPR) is a primary source of complex internal and external changes on the body. To differentiate antemortem injuries from these artefacts caused during resuscitation is a major challenge for forensic medicine expert. Objectives: To identify the different types of iatrogenic artefacts and calculate the percentage of each type and to determine the various factors contributing to the occurrence of iatrogenic artefacts. Materials and Methods: We conducted a prospective, autopsy based observational study on 120 hospitalized deaths at the Department of Forensic Medicine & Toxicology, S.M.S. Medical College & Attached Group of Hospitals, Jaipur, between June 2024 and May 2025. Brought dead cases, Traumatic cases involving chest injury and cases of decomposed dead bodies were excluded. The autopsy findings were systematically cross matched with clinical hospital records. Results: Resuscitation caused injuries were confirmed in 51.67% (n=62) of the total cases. Skeletal damage was frequently seen: left-sided rib fractures occurred in 38.33% (n=46) of cases, right-sided rib fractures in 27.50% (n=33), and sternal fractures in 15.00% (n=18). A severe combination injury involving left ribs, right ribs, and the sternum at the same time was found in 7.50% (n=9) of cases. Other than these skeletal injury, on further dissection revealed artificial airway-related trauma in 75.00% (n=90), pharyngeal mucosal bleeding due to digital manipulation in 51.67% (n=62), local changes from noradrenaline injections in 34.17% (n=41), mouth to mouth breathing markers in 20.83% (n=25), and defibrillator induced injuries in 16.67% (n=20). Conclusion: Resuscitation procedures produce a high number of wounds that can be easily confused with traumatic injuries. Forensic practitioners must perform detailed external and internal examination while thoroughly correlating findings with hospital treatment record to prevent wrong judicial judgement regarding violence, assault, or medical malpractice cases.

Keywords: Iatrogenic artefacts, Cardiopulmonary resuscitation, Rib fractures, Medico-legal autopsy, Forensic pathology.