Richard Scheithauer

SERIOUS COMPLICATIONS FROM ACTIVE COMPRESSION-DECOMPRESSION CARDIOPULMONARY RESUSCITATION

Complications arising from techniques of cardiopulmonary resuscitation (CPR) were reviewed by analysing the autopsy protocols of 25 patients who died after standard (Std) CPR and 31 who died after active compression-decompression (ACD) CPR, 15 of them preceded by Std CPR.The results can be summarised as follows:After Std CPR (n = 25) rib fractures were detected in 28%, sternal fractures in 16%, and no injuries in 68%.After ACD-CPR (n = 16) rib fractures occurred in 68%, sternal fractures in 68% and no injuries in 25%.After ACD-CPR following Std CPR(n = 15) rib fractures were detected in 93%, sternal fractures in 93%, and no patients were without thoracic fracture. In two patients severe cardiac injuries occurred clearly attributable to CPR.In conclusion cardiopulmonary resuscitation by the ACD-technique caused rib and sternal fractures more often than Std CPR and has a higher risk for iatrogenic cardiac and possible fatal injury.

Forensic validation of the SNPforID 52-plex assay

The advantages of single nucleotide polymorphism (SNP) typing in forensic genetics are well known and include a wider choice of high-throughput typing platforms, lower mutation rates, and improved analysis of degraded samples. However, if SNPs are to become a realistic supplement to current short tandem repeat (STR) typing methods, they must be shown to successfully and reliably analyse the challenging samples commonly encountered in casework situations. The European SNPforID consortium, supported by the EU GROWTH programme, has developed a multiplex of 52 SNPs for forensic analysis, with the amplification of all 52 loci in a single reaction followed by two single base extension (SBE) reactions which are detected with capillary electrophoresis. In order to validate this assay, a variety of DNA extracts were chosen to represent problems such as low copy number and degradation that are commonly seen in forensic casework. A total of 40 extracts were used in the study, each of which was sent to two of the five participating laboratories for typing in duplicate or triplicate. Laboratories were instructed to carry out their analyses as if they were dealing with normal casework samples. Results were reported back to the coordinating laboratory and compared with those obtained from traditional STR typing of the same extracts using Powerplex 16 (Promega). These results indicate that, although the ability to successfully type good quality, low copy number extracts is lower, the 52-plex SNP assay performed better than STR typing on degraded samples, and also on samples that were both degraded and of limited quantity, suggesting that SNP analysis can provide advantages over STR analysis in forensically relevant circumstances. However, there were also additional problems arising from contamination and primer quality issues and these are discussed.

Results of a collaborative study of the EDNAP group regarding the reproducibility and robustness of the Y-chromosome STRs DYS19, DYS389 I and II, DYS390 and DYS393 in a PCR pentaplex format

A collaborative exercise was carried out by the European DNA Profiling Group (EDNAP) in the frame work of the STADNAP program, i.e. standardization of DNA profiling in Europe, in order to evaluate the performance of a Y-chromosome STR pentaplex, which includes the loci DYS19, DYS389 I and II, DYS390 and DYS393 and to determine whether uniformity of results could be achieved among different European laboratories. Laboratories were asked to analyze the five Y-STRs using singleplex and multiplex conditions in three bloodstains and one mixed stain (95% female and 5% male). All the laboratories reported the same results even for the mixed stain included in the exercise. This demonstrates the reproducibility and robustness of Y-chromosome STR typing even with multiplex formats and proves the usefulness of Y-STR systems for analyzing mixed stains with a male component.A total of 930 male samples from 10 different populations from Europe were also analysed for all the loci included in the pentaplex. Eight of these ten populations also included haplotype data. As for single gene analysis, haplotype diversity was higher in Germany and Italy and lower in Western European countries and Finland. Pairwise haplotype analysis shows the Finnish departure from the rest of the populations and a relatively homogeneity in the other European populations with F(ST) estimates lower than 0.05.UPGMA analysis shows an association of Western European population (Ireland, UK, Portugal and Galicia) on the one hand and central European populations on the other.

Review of active compression-decompression cardiopulmonary resuscitation (ACD-CPR) Analysis of iatrogenic complications and their biomechanical explanation

Our review takes a critical look at the active compression-decompression technique (ACD) for cardiopulmonary resuscitation (CPR). ACD-CPR was developed following a report of successful resuscitation performed by a medical amateur using a household plunger. The efficacy of the principle of active decompression has been demonstrated by animal and human studies. Potential iatrogenic complications from the CardioPump were evaluated only when large clinical trials were already underway. Our prospective analysis of autopsy patients and systematic randomised studies in corpses prove that ACD-CPR using the CardioPump considerably increases the rate of iatrogenic complications and especially of sternum fractures. The experimental use of the CardioPump in corpses and the analysis of a variety of different parameters, especially of the rubber cushion pads mounted in the silicone cup to prevent skin abrasions, revealed a statistically significant correlation between sternum fractures and female sex (P < 0.01) and usage of the rubber cushion pad (P = 0.045). Biomechanical studies showed that the transmission of forces from the CardioPump is greatly dependent on chest shape. The lower the sternum is sunken compared with the surrounding structures, the higher the force which is transmitted via the central area of the device onto the sternum. The rubber cushion pad shortens the distance between CardioPump and sternum by 5 mm and therefore increases the sternal loading. Sex differences in the shape of the sternum and especially the thickness may account for the significant correlation between sternum fractures and female sex.

Population genetics of ten STR loci (AmpFℓSTR SGM plus) in Austria

Abstract A population study on the ten short tandem repeat (STR) loci D3S1358, VWA, D16S539, D2S1338, D8S1179, D21S11, D18S51, D19S433, TH01 and FGA was performed on 204 unrelated Austrian Caucasians. The DNA was amplified by multiplex PCR using the AmpFℓSTR SGM plus kit. All loci met Hardy-Weinberg expectations. The combined power of exclusion for the ten STR loci was 0.999976. The results show that these loci are very useful for forensic purposes.

STR loci Penta D and Penta E: Austrian Caucasian population data.

Abstract Allele frequencies for the short tandem repeat (STR) loci Penta D and Penta E, included in the PowerPlex 16 kit were obtained from a sample of 269 unrelated Austrian Caucasian individuals. Both loci met Hardy-Weinberg expectations.