A CLINICAL STUDY ON THE INVESTIGATION OF THE CAUSE OF A PATIENT'S DEATH AFTER CARDIOPULMONARY ARREST ON ARRIVAL

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  • KATO Akihito
    Department of Legal Medicine, Showa University School of Medicine
  • Keizo SATO Keizo SATO
    Department of Legal Medicine, Showa University School of Medicine
  • FUJISHIRO Masaya
    Department of Legal Medicine, Showa University School of Medicine
  • NITTONO Susumu
    Department of Legal Medicine, Showa University School of Medicine
  • HAYASHI Daigo
    Department of Legal Medicine, Showa University School of Medicine
  • KITO Masahiro
    Department of Legal Medicine, Showa University School of Medicine
  • NEMOTO Tetsuya
    Department of Legal Medicine, Showa University School of Medicine
  • LEE Xiao-Pen
    Department of Legal Medicine, Showa University School of Medicine
  • HAYASHI Munetaka
    Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital
  • NARIHARA Kentaro
    Department of Emergency and Critical Care Medicine, Showa University Fujigaoka Hospital

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Other Title
  • 来院時心肺停止死亡例の死因究明方法についての臨床的検討
  • ライインジ シンパイ テイシ シボウレイ ノ シイン キュウメイ ホウホウ ニ ツイテ ノ リンショウテキ ケントウ

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Abstract

The investigation of the cause of a patient's death after cardiopulmonary arrest (CPA) on arrival usually requires an autopsy. In most areas in Japan, however, such an autopsy is rarely performed, except for those areas with a medical examiner system. No reports demonstrating how to investigate the cause of the patient's death after CPA on arrival were found to our knowledge. From September 1, 2007 to August 31, 2010, 1121 CPA patients died in spite of cardiopulmonary resuscitation in the Emergency and Critical Care Center at Showa University Fujigaoka Hospital. In this paper, causes of their death were reexamined using medical records, roentgenograms of their chest and abdomen in addition to computed tomography (CT) films when taken. Further, the means by which to investigate the cause of death was studied. The detailed reexamination resulted in the estimation for causes of 652 (58.2%) patients' death as follows: 67 cardiac, 61 aortic, 75 respiratory, 44 cerebral, 25 alimentary, 20 renal, 57 systemic diseases and 303 external deaths. Causes of 469 (41.8%) patients' death were unknown. Although CT examination was performed for 219 patients (26.0%), the cause of 75 patient deaths could not be estimated. Reexaminations of medical records revealed 379 prodromes of 300 CPA patients (26.8%), but no prodromes indicated any specific disease. Anamneses were partly useful for specifying causes of their death. On the other hand, CT examinations were highly useful for not only diagnosing the specific disease but also denying it. Even when causes of their death could not be specified, reexaminations of both CT findings and other clinical data resulted in possible diagnoses of the disease for most cases. The spread of a medical examiner system throughout Japan is the most desirable for investigating causes of CPA patients' death. The postmortem CT examination seems to be preferable for such an investigation.

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