Correlation of pulmonary fat embolism with trauma and resuscitation in children

TL;DR

This study finds that pulmonary fat embolism in children is more common with trauma and resuscitation, especially when intraosseous catheters are used.

Contribution

The study identifies fatty tissue crushing as a novel predictor of pulmonary fat embolism in children, independent of fractures.

Findings

PFE was more frequent in trauma cases with resuscitation and intraosseous catheters.

Fat tissue crushing extent correlated with PFE development, even without fractures.

CPR alone did not strongly predict PFE, but intraosseous catheters were associated with moderate PFE grades.

Abstract

This study aims to investigate the correlation between pulmonary fat embolism (PFE), blunt force trauma and the effects of resuscitation in pediatric fatalities.

Data for this study covered deaths of 57 children aged 0 to 10 years, which underwent full autopsy at the Zurich Institute of Forensic Medicine from 2019 to 2023. Variables collected included anamnestic information on the presence of trauma (accidental, non-accidental), fracture and fatty tissue crushing extent, cardiopulmonary resuscitation (CPR) - with and without intraosseous catheter - and the grade of pulmonary fat embolism (PFE) according to Falzi et al.

The study analyzed 57 pediatric autopsy cases and found that PFE occurred more frequently in cases with both trauma and resuscitation, particularly when intraosseous catheters were used. Fat tissue crushing extent and fracture extent correlated with PFE development, while CPR alone did not. Notably, PFE could arise without fractures, likely due to fatty tissue crushing, and the highest PFE grades were observed in trauma cases with extensive fat crushing.

PFE can arise without fractures, likely from fatty tissue crushing alone. CPR with intraosseous catheters, correlated with moderate PFE (Falzi grade 2), but CPR alone did not strongly predict PFE in children.