Cardiac massage in infants

Objectives To evaluate the risk of cardiac injury during a prolonged external cardiac massage in infants. Methods A 3-month-old Caucasian boy with no known history of medical problems became unconscious while lying in a pram pushed by his parents. The baby had been taken to the hospital where external cardiac massage was performed for a total of 90 minutes. Sixteen hours from the start of resuscitation attempts, the heart resumed sporadic beating (aided by sporadic emergency maneuvers) with EKG finding of right bundle branch block and downsloping of the ST segment, but no clear-cut sign of ischemia The baby remained persistently unconscious and was pronounced dead 26 hours after hospitalization. Results Postmortem histological examination confirmed the clinical suspect of SIDS. In the right sino-atrial area and in the uppermost ventricular septum there was a wide myofibrillary injury, similar to the contraction band characteristic of hyperacute infarction. Conclusions Our case acquires an unique interest about the theoretical role the exaggerated infant cardiac massage might have played in the temporary survival and lethal outcome. The query if such phenomenon bespeaks for or against overdone cardiac massage is wide open.