Facial petechial hemorrhages after cardiopulmonary resuscitation in adults: A pilot study.
Forensic science international · 2026-06-05 · Observational study
Abstract
INTRODUCTION: Facial petechial hemorrhages (FPH) are small dermal or mucosal hemorrhages traditionally associated with impaired venous return, including neck or thorax compression in forensic contexts. Cardiopulmonary resuscitation (CPR) generates major intrathoracic pressure fluctuations and mechanical forces that could theoretically contribute to FPH formation, but available evidence is limited and confounded. This pilot study aimed to determine the prevalence and duration of FPH after CPR in adults and to explore patient and treatment characteristics associated with their occurrence. METHODS: We performed a prospective observational study among adults who underwent in- or prehospital CPR and were subsequently admitted to a regional teaching hospital from 01 to july 1st 2022 to June 1st 2025. Physicians assessed the presence of FPH at four time points: as soon as possible after CPR, and at approximately 24, 48, and 72 h. Data on demographics, medical history, cause of cardiac arrest, CPR duration, use of a mechanical chest compression device (AutoPulse®), and peri-arrest anticoagulant or antiplatelet therapy were retrospectively extracted from medical records. Statistical analyses included Chi-square tests and t-tests, with significance set at p ≤ 0.05. RESULTS: Seventy patients were analyzed. FPH were observed in 18 patients (25.7%) during the first examination, most frequently on the lip mucosa, conjunctivae, and eyelids. Of these 18 patients, only four patients had complete 72-hour follow-up; in two, FPH resolved within 24 h, and in two, between 48 and 72 h. No patient or treatment characteristics, including age, sex, medication use, CPR duration, or AutoPulse® use, showed significant associations with FPH, although longer CPR and mechanical compressions showed non-significant trends toward higher prevalence. CONCLUSION: This study demonstrates that FPH are relatively common after CPR and may persist up to 72 h. Although no specific patient or treatment factors were significantly associated with their occurrence, observed trends highlight the need for larger studies to better identify determinants of FPH after CPR and to support accurate clinical and forensic interpretation.