Myocardial injury attributable to external cardiac massage in infants

Given the complexity and stress of a cardiac massage, many mistakes are possible. While external cardiac massage is always advocated as a reanimatory maneuver, little attention if any has been given to the possibility of cardiac and cardiac conduction system lesions in infants during this emergency maneuver, whenever over practiced. The cardiac muscle forced to the bi-directional passive pseudo-contraction could undergo an irreversible myofibrillary injury, typical of contraction band degeneration observed in hyperacute infarction, and commonplace in the periphery of needle biopsy. Herein we report a case which acquires an interest for the myocardial histopathological lesions attributable to the prolonged external cardiac massage. An over insistent, protracted, energetic resuscitative maneuvers by external cardio-respiratory massage seems to abolish the hope to reanimate the patient through the maneuver itself.