Autopsy diagnosis after unsuccessful cardio-pulmonal resuscitation in patients following cardiac surgery

Aims: The most confident tool of confirming clinical diagnoses is the autopsy. However, autopsy rates are decreasing with advances in diagnostic tools. Our purpose was to evaluate the etiology of cardiac death in patients who died after unsuccessful cardio-pulmonal resuscitation (CPR) following cardiac surgery.

Methods: We retrospectively analyzed the autopsy reports of 64 patients who died following unsuccessful CPR after cardiac surgery between 1998 and 2005.

Results: The overall rate of performed autopsy in our department was 32%. 29.1% of these patients died following unsuccessful CPR. Mean age was 62.7±15.2 years. 56% were male. The time interval from the cardiac procedure to the time of CPR was 10.7±11.9 days, ranging from 0–50 days. The performed operation were coronary artery bypass grafting in 47% (n=30), valve replacement in 13% (n=8), cardiac transplantation in 14% (n=9), operation of an aortic dissection in 17% (n=11) and other procedures in 9% (n=6). In 45% (n=29) a reason for death could not be found during autopsy. These patients died most likely due to malignant ventricular arrhythmia. In 20% (n=13) autopsy revealed a thrombosis of the bypass graft. 17% (n=11) died due to bleeding from ruptured aortic dissection or aortic aneurysm.

Conclusion: Around one third of the patients in a cardiac surgery department are dying after unsuccessful CPR. In almost half of them the reason of death could not be verified in autopsy. However, one fifth showed thrombosis of the bypass graft as the reason for the cardiac arrest/fibrillation. Autopsy should be mandatory following cardiac operation.