Top

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Published in:

Open Access 01-12-2017 | Original research

Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study

Authors: Jin Ho Beom, Je Sung You, Min Joung Kim, Min Kyung Seung, Yoo Seok Park, Hyun Soo Chung, Sung Phil Chung, Incheol Park

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2017

Abstract

Background

The purpose of this study was to identify the relationship between the deeper and faster chest compressions suggested by the 2010 cardiopulmonary resuscitation guidelines and complications arising from chest compressions, using multi-detector computed tomography.

Methods

We performed a retrospective analysis of prospective registry data. This study was conducted with in- and out-of-hospital cardiac arrest patients who underwent successful resuscitation in the emergency departments of two academic tertiary care centres from October 2006 to September 2010 (pre-2010 group) and from October 2011 to September 2015 (post-2010 group). We examined chest injuries related to chest compressions, classified as follows: rib fracture, sternal fracture, and other uncommon complications.

Results

We enrolled 185 patients in this study. The most frequent complication to occur in both groups was rib fracture: 27 (62.8%) and 112 (78.9%) patients in the pre-2010 and post-2010 groups, respectively (p = 0.03). However, we observed no statistical differences in sternum fracture, the second most common complication (p = 0.80). Retrosternal and mediastinal haematoma were not reported in the pre-2010 group but 13 patients (9.1%) in the post-2010 group were reported to have haematoma (p = 0.04). Nine serious, life-threatening complications occurred, all in the post-2010 group. Among the younger group (less than 65 years old), 8 (38.1%) patients in the pre-2010 group and 40 (64.5%) in the post-2010 group sustained rib fractures.

Discussion

The deeper and faster chest compressions for enhancing ROSC are associated with increased occurrence of complications. Additional studies are needed to compensate for the limitations of our study design.

Conclusions

This study found that the 2010 guidelines, recommending deeper and faster chest compressions, led to an increased proportion of rib fractures and retrosternal and mediastinal haematoma.

Berg RA, Hemphill R, Abella BS, et al. Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:685–705.CrossRef

Koster RW, Baubin MA, Bossaert LL, et al. European Resuscitation Council guidelines for resuscitation 2010 section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2010;81:1277–92.CrossRefPubMed

Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S, Bossaert L. European Resuscitation Council Guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2005;67:S7–S23.CrossRefPubMed

Stiell IG, Brown SP, Christenson J, et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation? Crit Care Med. 2012;40:1192–8.CrossRefPubMedPubMedCentral

Young N, Cook B, Gillies M. New resuscitation guidelines may result in an increased incidence of severe chest wall injury, and lead to prolonged length of stay in the Intensive Care Unit. Resuscitation. 2011;82:1355.CrossRefPubMed

Kralj E, Podbregar M, Kejžar N, Balažic J. Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered. Resuscitation. 2015;93:136–41.CrossRefPubMed

Hellevuo H, Sainio M, Nevalainen R, et al. Deeper chest compression – more complications for cardiac arrest patients. Resuscitation. 2013;84:760–5.CrossRefPubMed

Kashiwagi Y, Sasakawa T, Tampo A, et al. Computed tomography findings of complications resulting from cardiopulmonary resuscitation. Resuscitation. 2015;88:86–91.CrossRefPubMed

Smekal D, Lindgren E, Sandler H, Johansson J, Rubertsson S. CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device: a multicentre study of victims after unsuccessful resuscitation. Resuscitation. 2014;85:1708–12.CrossRefPubMed

10.

Lederer W, Mair D, Rabl W, Baubin M. Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest x-ray. Resuscitation. 2004;60:157–62.CrossRefPubMed

11.

Smekal D, Hansen T, Sandler H, Rubertsson S. Comparison of computed tomography and autopsy in detection of injuries after unsuccessful cardiopulmonary resuscitation. Resuscitation. 2013;84:357–60.CrossRefPubMed

12.

Schulze C, Hoppe H, Schweitzer W, Schwendener N, Grabherr S, Jackowski C. Rib fractures at postmortem computed tomography (PMCT) validated against the autopsy. Forensic Sci Int. 2013;233:90–8.CrossRefPubMed

13.

Kim MJ, Park YS, Kim SW, et al. Chest injury following cardiopulmonary resuscitation: a prospective computed tomography evaluation. Resuscitation. 2013;84:361–4.CrossRefPubMed

14.

Kim EY, Yang HJ, Sung YM, et al. Multidetector CT findings of skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation. 2011;82:1285–8.CrossRefPubMed

15.

Cho SH, Kim EY, Choi SJ, et al. Multidetector CT and radiographic findings of lung injuries secondary to cardiopulmonary resuscitation. Injury. 2013;44:1204–7.CrossRefPubMed

16.

Mullinix AJ, Foley WD. Multi-detector computed tomography and blunt thoracoabdominal trauma. J Comput Assist Tomogr. 2004;28 Suppl 1:S20–7.CrossRefPubMed

17.

Health statistics and information systems: Definition of an older or elderly person. World Health Organization, 2016 (Accessed 14 Nov 2016, at http://www.who.int/healthinfo/survey/ageingdefnolder/en/)

18.

Perers E, Abrahamsson P, Bång A, et al. There is a difference in characteristics and outcome between women and men who suffer out of hospital cardiac arrest. Resuscitation. 1999;40:133–40.CrossRefPubMed

19.

Rabl W, Baubin M, Haid C, Pfeiffer KP, Scheithauer R. Review of active compression-decompression cardiopulmonary resuscitation (ACD-CPR). Analysis of iatrogenic complications and their biomechanical explanation. Forensic Sci Int. 1997;89:175–83.CrossRefPubMed

20.

Ihnát Rudinská L, Hejna P, Ihnát P, Tomášková H, Smatanová M, Dvořáček I. Intra-thoracic injuries associated with cardiopulmonary resuscitation – Frequent and serious. Resuscitation. 2016;103:66–70.CrossRefPubMed

21.

Buschmann C, Schulz T, Tsokos M, Kleber C. Emergency medicine technique and the forensic autopsy. Forensic Sci Med Pathol. 2013;9:48–67.CrossRefPubMed

22.

Black C, Busuttil A, Robertson C. Chest wall injuries following cardiopulmonary resuscitation. Resuscitation. 2004;63:339–43.CrossRefPubMed

23.

Smekal D, Johansson J, Huzevka T, Rubertsson S. No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compression compared with mechanical compressions with the LUCAS device--a pilot study. Resuscitation. 2009;80:1104–7.CrossRefPubMed

24.

Hashimoto Y, Moriya F, Furumiya J. Forensic aspects of complications resulting from cardiopulmonary resuscitation. Legal Med (Tokyo). 2007;9:94–9.CrossRef

25.

Seung MK, You JS, Lee HS, Park YS, Chung SP, Park I. Comparison of complications secondary to cardiopulmonary resuscitation between out-of- hospital cardiac arrest and in-hospital cardiac arrest. Resuscitation. 2016;98:64–72.CrossRefPubMed

26.

Baubin M, Sumann G, Rabl W, Eibl G, Wenzel V, Mair P. Increased frequency of thorax injuries with ACD-CPR. Resuscitation. 1999;41:33–8.CrossRefPubMed

27.

Mirvis SE. Imaging of acute thoracic injury: the advent of MDCT screening. Semin Ultrasound CT MRI. 2005;26:305–31.CrossRef

28.

Oberladstaetter D, Braun P, Freund MC, et al. Autopsy is more sensitive than computed tomography in detection of LUCAS-CPR related non-dislocated chest fractures. Resuscitation. 2012;83:e89–90.CrossRefPubMed

Title: Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study
Authors: Jin Ho Beom
Je Sung You
Min Joung Kim
Min Kyung Seung
Yoo Seok Park
Hyun Soo Chung
Sung Phil Chung
Incheol Park
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2017
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-017-0352-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study

Abstract

Background

Methods

Results

Discussion

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Discussion

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

The golden hour of acute ischemic stroke

Can we rely on out-of-hospital blood samples? A prospective interventional study on the pre-analytical stability of blood samples under prehospital emergency medicine conditions

S100A8/A9 and sRAGE kinetic after polytrauma; an explorative observational study

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Presentations to an urban emergency department in Bern, Switzerland associated with acute recreational drug toxicity

Anaphylaxis in an emergency care setting: a one year prospective study in children and adults