CPR-induced vertebral fractures: a case report and systematic review of literature

Abstract

Background

Cardiopulmonary resuscitation is a critical intervention for cardiac arrest, but its forceful chest compressions can lead to skeletal injuries, including rare vertebral fractures

Case presentation

This case report details a 78-year-old woman with a history of cardiac surgery and obesity who suffered a fatal cardiac arrest due to a DeBakey type II aortic dissection. Despite 30 minutes of advanced manual CPR, she succumbed to cardiogenic shock. Autopsy revealed an incidental transvertebral fracture of the 8th thoracic vertebra alongside multiple bilateral rib fractures, with no evidence of pre-existing trauma

Literature review

A systematic literature search was conducted in three major scientific databases and reported according to PRISMA 2020, with structured eligibility criteria and methodological quality appraisal of included reports. Results were evaluated by two independent reviewers. Data on demographics, anatomy, bone comorbidities, and CPR were extracted independently and reviewed collectively

Conclusions

A systematic literature review of 16 studies identified 23 cases of CPR-related vertebral fractures, predominantly in the mid-to-lower thoracic spine, with Th10 being the most affected level. Pre-existing conditions such as osteopenia, osteoporosis, and kyphosis increase susceptibility to these injuries by compromising spinal integrity. The biomechanical forces of CPR, combined with structural vulnerabilities, contribute to this rare complication. This case underscores the importance of post-mortem examinations in distinguishing CPR-related injuries from traumatic causes, aiding forensic investigations. Clinicians and forensic pathologists should remain vigilant for vertebral fractures as a potential CPR complication, particularly in elderly patients with predisposing bone conditions, to ensure accurate diagnosis and avoid medico-legal issues.