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Van Wijck SFM, Prins JTH, Verhofstad MHJ, Wijffels MME, Van Lieshout EMM. Rib fractures and other injuries after cardiopulmonary resuscitation for non-traumatic cardiac arrest: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02421-7. [PMID: 38206442 DOI: 10.1007/s00068-023-02421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE This study aims to ascertain the prevalence of rib fractures and other injuries resulting from CPR and to compare manual with mechanically assisted CPR. An additional aim was to summarize the literature on surgical treatment for rib fractures following CPR. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Medline Ovid, Cochrane Central, Web of Science, and Google Scholar. REVIEW METHODS The databases were searched to identify studies reporting on CPR-related injuries in patients who underwent chest compressions for a non-traumatic cardiopulmonary arrest. Subgroup analysis was conducted to compare the prevalence of CPR-related injuries in manual versus mechanically assisted chest compressions. Studies reporting on surgery for CPR-related rib fractures were also reviewed and summarized. RESULTS Seventy-four studies reporting CPR-related injuries were included encompassing a total of 16,629 patients. Any CPR-related injury was documented in 60% (95% confidence interval [95% CI] 49-71) patients. Rib fractures emerged as the most common injury, with a pooled prevalence of 55% (95% CI 48-62). Mechanically assisted CPR, when compared to manual CPR, was associated with a higher risk ratio for CPR-related injuries of 1.36 (95% CI 1.17-1.59). Eight studies provided information on surgical stabilization of CPR-related rib fractures. The primary indication for surgery was the inability to wean from mechanical ventilation in the presence of multiple rib fractures. CONCLUSION Rib fractures and other injuries frequently occur in patients who undergo CPR after a non-traumatic cardiopulmonary arrest, especially when mechanical CPR is administered. Surgical stabilization of CPR-related rib fractures remains relatively uncommon. LEVEL OF EVIDENCE Level III, systematic review and meta-analysis.
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Affiliation(s)
- Suzanne F M Van Wijck
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jonne T H Prins
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Mathieu M E Wijffels
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Dąbrowski S, Lange S, Basiński A. Analgesic Use in Patients during Cardio-Pulmonary Resuscitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3654. [PMID: 36834346 PMCID: PMC9961124 DOI: 10.3390/ijerph20043654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Cardiopulmonary resuscitation-induced consciousness is a newly recognized phenomenon with an increasing incidence. A return of consciousness during cardiopulmonary resuscitation affects up to 0.9% of cases. Patients may also experience physical pain associated with chest compressions, as most victims of cardiac arrest who are subjected to resuscitative efforts sustain ribs or sternum fractures. METHODS A rapid review was carried out from August 2021 to December 2022. RESULTS Thirty-two articles were included in the rapid review. Of these, eleven studies focused on the return of consciousness during CPR, and twenty-one on CPR-induced chest injuries. CONCLUSION A small number of studies that have dealt with the return of consciousness associated with cardiopulmonary resuscitation made it hard to clearly determine how often this occurs. There were more studies that dealt with chest trauma during resuscitation, but no study considered the use of analgesics. Of note, there was no standardized therapeutic approach as far as the use of analgesics and/or sedatives was considered. This is probably due to the lack of guidelines for analgesic management during cardiopulmonary resuscitation and peri-resuscitative period.
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Affiliation(s)
- Sebastian Dąbrowski
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Sandra Lange
- Department of Internal and Pediatric Nursing, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Andrzej Basiński
- Department of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
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Petrovich P, Berve PO, Barth-Heyerdahl Roald B, Wahl Kongsgård H, Stray-Pedersen A, Kramer-Johansen J, Wik L. Injuries associated with mechanical chest compressions and active decompressions after out-of-hospital cardiac arrest: A subgroup analysis of non-survivors from a randomized study. Resusc Plus 2023; 13:100362. [PMID: 36798487 PMCID: PMC9926013 DOI: 10.1016/j.resplu.2023.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/08/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Background Both skeletal and visceral injuries are reported after cardiopulmonary resuscitation (CPR). This subgroup analysis of a randomized clinical study describes/compares autopsy documented injury patterns caused by two mechanical, piston-based chest compression devices: standard LUCAS® 2 (control) and LUCAS® 2 with active decompression (AD, intervention) in non-survivors with out-of-hospital cardiac arrest (CA). Method We compared injuries documented by autopsies (medical/forensic) after control and intervention CPR based on written relatives consent to use patients' data. The pathologists were blinded for the device used. The cause of CA and injuries reported were based on a prespecified study autopsy template. We used Pearson's chi-squared test and logistic regression analysis with an alpha level of 0.05. Results 221 patients were included in the main study (April 2015-April 2017) and 207 did not survive. Of these, 114 (55%, 64 control and 50 intervention) underwent medical (N = 73) or forensic (N = 41) autopsy. The cause of CA was cardiac 53%, respiratory 17%, overdose/intoxication 14%, ruptured aorta 10%, neurological 1%, and other 5%. There were no differences between control and intervention in the incidence of rib fractures (67% vs 72%; p-value = 0.58), or sternal fractures (44% vs 48%; p-value = 0.65), respectively. The most frequent non-skeletal complication was bleeding (26% of all patients) and intrathoracic was the most common location. Ten of the 114 patients had internal organ injuries, where lungs were most affected. Conclusion In non-survivors of OHCA patients, the most frequent cause of cardiac arrest was cardiogenic. Skeletal and non-skeletal fractures/injuries were found in both control and intervention groups. Bleeding was the most common non-skeletal complication. Internal organ injuries were rare.
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Affiliation(s)
- Polina Petrovich
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Per Olav Berve
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway,Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Borghild Barth-Heyerdahl Roald
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway,Department of Pathology, Oslo University Hospital, Norway
| | - Håvard Wahl Kongsgård
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway
| | - Arne Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway,Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Norway
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway,Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Lars Wik
- Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway,Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway,Corresponding author at: Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.
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4
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Kopra J, Litonius E, Pekkarinen PT, Laitinen M, Heinonen JA, Fontanelli L, Mäkiaho TP, Skrifvars MB. Ventilation during continuous compressions or at 30:2 compression-to-ventilation ratio results in similar arterial oxygen and carbon dioxide levels in an experimental model of prolonged cardiac arrest. Intensive Care Med Exp 2023; 11:3. [PMID: 36607514 PMCID: PMC9823175 DOI: 10.1186/s40635-022-00485-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/17/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In refractory out-of-hospital cardiac arrest, transportation to hospital with continuous chest compressions (CCC) from a chest compression device and ventilation with 100% oxygen through an advanced airway is common practice. Despite this, many patients are hypoxic and hypercapnic on arrival, possibly related to suboptimal ventilation due to the counterpressure caused by the CCC. We hypothesized that a compression/ventilation ratio of 30:2 would provide better ventilation and gas exchange compared to asynchronous CCC during prolonged experimental cardiopulmonary resuscitation (CPR). METHODS We randomized 30 anaesthetized domestic swine (weight approximately 50 kg) with electrically induced ventricular fibrillation to the CCC or 30:2 group and bag-valve ventilation with a fraction of inspired oxygen (FiO2) of 100%. We started CPR after a 5-min no-flow period and continued until 40 min from the induction of ventricular fibrillation. Chest compressions were performed with a Stryker Medical LUCAS® 2 mechanical chest compression device. We collected arterial blood gas samples every 5 min during the CPR, measured ventilation distribution during the CPR using electrical impedance tomography (EIT) and analysed post-mortem computed tomography (CT) scans for differences in lung aeration status. RESULTS The median (interquartile range [IQR]) partial pressure of oxygen (PaO2) at 30 min was 110 (52-117) mmHg for the 30:2 group and 70 (40-171) mmHg for the CCC group. The median (IQR) partial pressure of carbon dioxide (PaCO2) at 30 min was 70 (45-85) mmHg for the 30:2 group and 68 (42-84) mmHg for the CCC group. No statistically significant differences between the groups in PaO2 (p = 0.40), PaCO2 (p = 0.79), lactate (p = 0.37), mean arterial pressure (MAP) (p = 0.47) or EtCO2 (p = 0.19) analysed with a linear mixed model were found. We found a deteriorating trend in PaO2, EtCO2 and MAP and rising PaCO2 and lactate levels through the intervention. There were no differences between the groups in the distribution of ventilation in the EIT data or the post-mortem CT findings. CONCLUSIONS The 30:2 and CCC protocols resulted in similar gas exchange and lung pathology in an experimental prolonged mechanical CPR model.
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Affiliation(s)
- Jukka Kopra
- grid.15485.3d0000 0000 9950 5666Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erik Litonius
- grid.7737.40000 0004 0410 2071Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pirkka T. Pekkarinen
- grid.7737.40000 0004 0410 2071Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Merja Laitinen
- VetCT Teleconsulting–Teleradiology Small Animal Team, Cambridge, UK
| | - Juho A. Heinonen
- grid.7737.40000 0004 0410 2071Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Luca Fontanelli
- grid.8982.b0000 0004 1762 5736Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy
| | - Tomi P. Mäkiaho
- grid.15485.3d0000 0000 9950 5666Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Markus B. Skrifvars
- grid.15485.3d0000 0000 9950 5666Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Waqar A, Rajput F, Rachwan RJ, Abi-Saab T, Gimelli G. LUCAS compression device-related severe injuries in a series of patients presenting with outside hospital cardiac arrest. J Cardiol Cases 2022; 26:432-435. [PMID: 36506494 PMCID: PMC9727558 DOI: 10.1016/j.jccase.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
Abstract
This case series presents patients who presented to the hospital with an outside hospital cardiac arrest and were initially resuscitated successfully. All patients suffered fatal traumatic injuries during the resuscitation process with the common variable being the use of mechanical cardiopulmonary resuscitation (CPR) device. The goal of this case series is to describe the limitations and potential fatal side effects of CPR. We also present a review of literature with our impressions of the appropriate indications for the use of mechanical CPR. Learning objectives 1) Recognize appropriate indications for the use of mechanical vs manual cardiopulmonary resuscitation (CPR). 2) Identify signs and symptoms of mechanical CPR-related complications.
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Affiliation(s)
- Aneeq Waqar
- Department of Cardiovascular Medicine, University of Wisconsin, Madison, WI, USA,Corresponding author at: Department of Cardiovascular Medicine, University of Wisconsin, Madison, WI, USA.
| | - Furqan Rajput
- Department of Cardiovascular Medicine, University of Wisconsin, Madison, WI, USA
| | - Rayan Jo Rachwan
- Department of Cardiovascular Medicine, University of Wisconsin, Madison, WI, USA
| | - Tarek Abi-Saab
- Department of Pathology, University of Wisconsin, Madison, WI, USA
| | - Giorgio Gimelli
- Department of Cardiovascular Medicine, University of Wisconsin, Madison, WI, USA
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Kawai Y, Takano K, Miyazaki K, Yamamoto K, Tada Y, Asai H, Maegawa N, Urisono Y, Saeki K, Fukushima H. Association of multiple rib fractures with the frequency of pneumonia in the post-resuscitation period. Resusc Plus 2022; 11:100267. [PMID: 35812719 PMCID: PMC9256829 DOI: 10.1016/j.resplu.2022.100267] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/11/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Successful cardiopulmonary resuscitation is associated with a high incidence of chest wall injuries. However, few studies have examined chest wall injury as a risk factor for respiratory complications after cardiopulmonary resuscitation. Therefore, herein, we investigated the association of multiple rib fractures on the incidence of post-resuscitation pneumonia. Methods This single-centre retrospective cohort study enrolled adult, nontraumatic, out-of-hospital cardiac arrest patients who maintained circulation for more than 48 h between June 2015 and May 2019. Rib fractures were evaluated by computed tomography on the day of hospital admission. The association with newly developed pneumonia within 7 days of hospitalisation was analysed using a Fine-Gray proportional hazards regression model adjusted for the propensity score of multiple rib fractures estimated from age, sex, presence of witnessed status, bystander CPR, initial rhythm, and total CPR time and for previously reported risk factors for pneumonia (therapeutic hypothermia and prophylactic antibiotics). Results Overall, 683 patients with out-of-hospital cardiac arrest were treated; 87 eligible cases were enrolled for analysis. Thirty-two (36.8%) patients had multiple rib fractures identified on computed tomography, and 35 (40.2%) patients developed pneumonia. The presence of multiple rib fractures was significantly associated with a higher incidence of pneumonia, consistently both with and without adjustment for background factors (unadjusted hazard ratio 4.63, 95% confidence interval: 2.35–9.13, p < 0.001; adjusted hazard ratio 4.03, 95% confidence interval: 2.08–7.82, p < 0.001). Conclusions Multiple rib fractures are independently associated with the development of pneumonia after successful resuscitation.
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Gödde D, Bruckschen F, Burisch C, Weichert V, Nation KJ, Thal SC, Marsch S, Sellmann T. Manual and Mechanical Induced Peri-Resuscitation Injuries-Post-Mortem and Clinical Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10434. [PMID: 36012068 PMCID: PMC9408363 DOI: 10.3390/ijerph191610434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
(1) Background: Injuries related to resuscitation are not usually systematically recorded and documented. By evaluating this data, conclusions could be drawn about the quality of the resuscitation, with the aim of improving patient care and safety. (2) Methods: We are planning to conduct a multicentric, retrospective 3-phased study consisting of (1) a worldwide literature review (scoping review), (2) an analysis of anatomical pathological findings from local institutions in North Rhine-Westphalia, Germany to assess the transferability of the review data to the German healthcare system, and (3) depending on the results, possibly establishing potential prospective indicators for resuscitation-related injuries as part of quality assurance measures. (3) Conclusions: From the comparison of literature and local data, the picture of resuscitation-related injuries will be focused on and quality indicators will be derived.
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Affiliation(s)
- Daniel Gödde
- Department of Pathology and Molecularpathology, Helios University Hospital Wuppertal, University Witten/Herdecke, 58455 Witten, Germany
| | - Florian Bruckschen
- Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus BETHESDA zu Duisburg, 47053 Duisburg, Germany
| | - Christian Burisch
- State of North Rhine-Westphalia/Regional Government, 44145 Düsseldorf, Germany
| | - Veronika Weichert
- Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Duisburg, 47249 Duisburg, Germany
| | - Kevin J. Nation
- NZRN, New Zealand Resuscitation Council, Wellington 6011, New Zealand
| | - Serge C. Thal
- Department of Anaesthesiology I, University Witten/Herdecke, 58455 Witten, Germany
- Department of Anesthesiology, HELIOS University Hospital, 42283 Wuppertal, Germany
| | - Stephan Marsch
- Department of Intensive Care, University Hospital, Petersgraben 4, 4031 Basel, Switzerland
| | - Timur Sellmann
- Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus BETHESDA zu Duisburg, 47053 Duisburg, Germany
- Department of Anaesthesiology I, University Witten/Herdecke, 58455 Witten, Germany
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Trauma associated with cardiopulmonary resuscitation based on autopsy reports after the 2015 ERC guidelines. Am J Emerg Med 2022; 61:81-86. [PMID: 36057213 DOI: 10.1016/j.ajem.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Cardiopulmonary resuscitation (CPR)-related injuries have not been assessed since the 2015 Resuscitation Guidelines were established. AIM To describe the incidence and severity of CPR-related injuries, and to evaluate the impact of the 2015 European Resuscitation Council (ERC) guidelines on the objective assessment of injuries. METHODS This multicenter, retrospective study analyzed autopsy reports of patients who underwent CPR. The most severe injuries were objectively assessed using the Abbreviated Injury Scale (AIS) and all injuries were summarized according to the New Injury Severity Score (NISS). RESULTS Among 628 autopsy reports analyzed, patient characteristics and case details were distributed as follows: male sex, 71.1%; median age, 67 years; out-of-hospital cardiac arrest, 89.2%; bystander CPR, 56.8%. CPR-related injuries included: rib(s) 94.6%; lung(s), 9.9%; sternum, 62.4%; liver, 2.5%; and spleen, 1.8%. The incidence of bystander-provided CPR and severity of injury were similar to CPR provided only by professionals. There were no difference between mechanical and manual compressions. Females were older (p = 0.0001) and, although the frequency of their injuries was similar to males, they were significantly more severe (p = 0.01). Patients with life-threatening injury exhibited a baseline profile similar to those without injury . The median score (according to AIS) of the most severe injury was 3 and the median of summary of injuries was 13 according to the NISS-low risk of fatal injury. CONCLUSION CPR-related injuries occurred frequently, although those that were life-threatening accounted for only 3% of cases. There were no differences between patients who were resuscitated by bystander(s) or by professionals and no differences between mechanical chest devices or manual resuscitation. Compared with a study based on the 2010 guidelines, similar injuries were found, but with more rib fractures, less visceral organ damage, and fewer life-threatening injuries.
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Coelho-Lima J, Westaby J, Sheppard MN. Cardiac arrest with successful cardiopulmonary resuscitation and survival induce histologic changes that correlate with survival time and lead to misdiagnosis in sudden arrhythmic death syndrome. Resuscitation 2022; 175:6-12. [DOI: 10.1016/j.resuscitation.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/15/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022]
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Adel J, Akin M, Garcheva V, Vogel-Claussen J, Bauersachs J, Napp LC, Schäfer A. Computed-Tomography as First-line Diagnostic Procedure in Patients With Out-of-Hospital Cardiac Arrest. Front Cardiovasc Med 2022; 9:799446. [PMID: 35187123 PMCID: PMC8850697 DOI: 10.3389/fcvm.2022.799446] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMortality after out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) remains high despite numerous efforts to improve outcome. For patients with suspected coronary cause of arrest, coronary angiography is crucial. However, there are other causes and potentially life-threatening injuries related to cardiopulmonary resuscitation (CPR), which can be detected by routine computed tomography (CT).Materials and MethodsAt Hannover Medical School, rapid coronary angiography and CT are performed in successfully resuscitated OHCA patients as a standard of care prior to admission to intensive care. We analyzed all patients who received CT following OHCA with ROSC over a three-year period.ResultsThere were 225 consecutive patients with return of spontaneous circulation following out-of-hospital cardiac arrest. Mean age was 64 ± 13 years, 75% were male. Of them, 174 (77%) had witnessed arrest, 145 (64%) received bystander CPR, and 123 (55%) had a primary shockable rhythm. Mean time to ROSC was 24 ± 20 min. There were no significant differences in CT pathologies in patients with or without ST-segment elevations in the initial ECG. Critical CT findings qualifying as a potential cause for cardiac arrest were intracranial bleeding (N = 6), aortic dissection (N = 5), pulmonary embolism (N = 17), pericardial tamponade (N = 3), and tension pneumothorax (N = 11). Other pathologies were regarded as consequences of CPR and relevant for further treatment: aspiration (N = 62), rib fractures (N = 161), sternal fractures (N = 50), spinal fractures (N = 11), hepatic bleeding (N = 12), and intra-abdominal air (N = 3).ConclusionEarly CT fallowing OHCA uncovers a high number of causes and consequences of OHCA and CPR. Those are relevant for post-arrest care and are frequently life-threatening, suggesting that CT can contribute to improving prognosis following OHCA.
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Affiliation(s)
- John Adel
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
- *Correspondence: Muharrem Akin
| | - Vera Garcheva
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
| | - L. Christian Napp
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
| | - Andreas Schäfer
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
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Karasek J, Slezak J, Stefela R, Topinka M, Blankova A, Doubková A, Pitasova T, Nahalka D, Bartes T, Hladik J, Adamek T, Jirasek T, Polasek R, Ostadal P. CPR-related injuries after non-traumatic out-of-hospital cardiac arrest: survivors versus non-survivors. Resuscitation 2022; 171:90-95. [PMID: 34995685 DOI: 10.1016/j.resuscitation.2021.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/04/2023]
Abstract
AIM There have been no direct comparisons of cardiopulmonary resuscitation (CPR)-related injuries between those who die during CPR and those who survive to intensive care unit (ICU) admission. This study aimed to compare the incidence, severity, and impact on survival rate of these injuries and potential influencing factors. METHOD This retrospective multicenter study analyzed autopsy reports of patients who experienced out-of-hospital cardiac arrest (OHCA) and were not admitted to hospital. CPR-related injuries were compared to OHCA patients with clinical suspicion of CPR-related injury confirmed on imaging when admitted to the ICU. RESULTS A total of 859 out-of-hospital cardiac arrests (OHCA) were divided into 2 groups: those who died during CPR and underwent autopsy (DEAD [n=628]); and those who experienced return of spontaneous circulation and admitted to the ICU (ICU [n=231]). Multivariable analyses revealed that independent factors of 30-day mortality included no bystander arrest, cardiac etiology, no shockable rhythm, and CPR-related injury. Trauma was independently associated with older age, bystander CPR, cardiac etiology, duration of CPR, and no defibrillation. CPR-related injury occurred in 30 (13%) patients in the ICU group and 547 (87%) in the DEAD group (p<0.0001). Comparison of injuries revealed that those in the DEAD group experienced more thoracic injuries, rib(s) and sternal fractures, and fewer liver injuries compared to those in the ICU group, without differences in injury severity. CONCLUSION CPR-related injuries were observed more frequently in those who died compared with those who survived to ICU admission. Injury was an independent factor of 30-day mortality.
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Affiliation(s)
- Jiri Karasek
- Department of Cardiology, Hospital Liberec, Liberec, Czech Republic; Third Medical Faculty, Charles University, Prague, Czech Republic; 2nd Department of Internal Medicine, Cardiovascular Medicine, General Teaching Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Jakub Slezak
- Third Medical Faculty, Charles University, Prague, Czech Republic
| | - Radek Stefela
- Third Medical Faculty, Charles University, Prague, Czech Republic
| | - Martin Topinka
- Third Medical Faculty, Charles University, Prague, Czech Republic
| | - Alzbeta Blankova
- Department of Forensic Medicine, Hospital Liberec, Liberec, Czech Republic
| | - Alena Doubková
- Third Medical Faculty, Charles University, Prague, Czech Republic
| | - Tereza Pitasova
- Third Medical Faculty, Charles University, Prague, Czech Republic
| | - David Nahalka
- Third Medical Faculty, Charles University, Prague, Czech Republic
| | - Tomas Bartes
- Third Medical Faculty, Charles University, Prague, Czech Republic
| | - Jiri Hladik
- Department of Forensic Medicine, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Tomas Adamek
- Department of Forensic Medicine, Hospital Liberec, Liberec, Czech Republic
| | - Tomas Jirasek
- Department of Forensic Medicine, Hospital Liberec, Liberec, Czech Republic
| | | | - Petr Ostadal
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
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Prins JTH, Van Lieshout EMM, Van Wijck SFM, Scholte NTB, Den Uil CA, Vermeulen J, Verhofstad MHJ, Wijffels MME. Chest wall injuries due to cardiopulmonary resuscitation and the effect on in-hospital outcomes in survivors of out-of-hospital cardiac arrest. J Trauma Acute Care Surg 2021; 91:966-975. [PMID: 34407009 DOI: 10.1097/ta.0000000000003379] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to assess the prevalence of chest wall injuries due to cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA) and to compare in-hospital outcomes in patients with versus without chest wall injuries. METHODS A retrospective cohort study of all intensive care unit (ICU)-admitted patients who underwent cardiopulmonary resuscitation for OHCA between January 1, 2007, and December 2019 was performed. The primary outcome was the occurrence of chest wall injuries, as diagnosed on chest computed tomography. Chest wall injury characteristics such as rib fracture location, type, and dislocation were collected. Secondary outcomes were in-hospital outcomes and subgroup analysis of patients with good neurological recovery to identify those who could possibly benefit from the surgical stabilization of rib fractures. RESULTS Three hundred forty-four patients were included, of which 291 (85%) sustained chest wall injury. Patients with chest wall injury had a median of 8 fractured ribs (P25-P75, 4-10 ribs), which were most often undisplaced (on chest computed tomography) (n = 1,574 [72.1%]), simple (n = 1,948 [89.2%]), and anterior (n = 1,785 [77.6%]) rib fractures of ribs 2 to 7. Eight patients (2.3%) had a flail segment, and 136 patients (39.5%) had an anterior flail segment. Patients with chest wall injury had fewer ventilator-free days (0 days [P25-P75, 0-16 days] vs. 13 days [P25-P75, 2-22 days]; p = 0.006) and a higher mortality rate (n = 102 [54.0%] vs. n = 8 [22.2%]; p < 0.001) than those without chest wall injury. For the subgroup of patients with good neurological recovery, the presence of six or more rib fractures or a single displaced rib fracture was associated with longer hospital and ICU length of stay, respectively. CONCLUSION Cardiopulmonary resuscitation-related chest wall injuries in survivors of OHCA and especially rib fractures are common. Patients with chest wall injury had fewer ventilator-free days and a higher mortality rate. Patients with good neurological recovery might represent a subgroup of patients who could benefit from surgical stabilization of rib fractures. LEVEL OF EVIDENCE Therapeutic, level IV; Epidemiological, Level IV.
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Affiliation(s)
- Jonne T H Prins
- From the Trauma Research Unit Department of Surgery (J.T.H.P., E.M.M.V.L., S.F.M.V.W., M.H.J.V., M.M.E.W.), Department of Clinical Epidemiology of Cardiovascular Diseases (N.T.B.S.), Department of Intensive Care (C.A.D.U.), and Department of Cardiology (C.A.D.U.), Erasmus MC, University Medical Center Rotterdam; and Department of Surgery (J.V.), Maasstad Ziekenhuis, Rotterdam, the Netherlands
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13
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Zaidi HQ, Li S, Beiser DG, Tataris KL, Sharp WW. The utility of computed tomography to evaluate thoracic complications after cardiopulmonary resuscitation. Resusc Plus 2021; 3:100017. [PMID: 34223300 PMCID: PMC8244247 DOI: 10.1016/j.resplu.2020.100017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/07/2020] [Accepted: 07/07/2020] [Indexed: 01/22/2023] Open
Abstract
Background Cardiopulmonary resuscitation (CPR) in adults following non-traumatic out of hospital cardiac arrest (OHCA) can cause thoracic complications including rib fractures, sternal fractures, and pneumothorax. Post-CPR complication rates are poorly studied and the optimum imaging modality to detect these complications post-resuscitation has not been established. Methods We performed a retrospective review of adult patients transported to a single, urban, academic hospital following atraumatic OHCA between September 2015 and January 2020. Patients who achieved sustained return of spontaneous circulation (ROSC) and who underwent computed tomography (CT) imaging of the chest following radiographic chest x-ray were included in the analyses. Patient demographics and prehospital data were collected. Descriptive statistics and multivariate logistic regression analysis were performed. Sensitivity and specificity of chest x-ray for the detection of thoracic injury in this population were estimated. Results 786 non-traumatic OHCA patients were transported to the ED, 417 of whom obtained sustained ROSC and were admitted to the hospital (53%). 137 (32.9%) admitted patients underwent CT imaging of the chest in the ED. Of these imaged patients median age was 62 years old (IQR 53–70) with 54.0% female and 38.0% of patients having received bystander CPR. 40/137 (29.2%) patients had skeletal fractures noted on CT imaging and 12/137 (8.8%) had pneumothorax present on CT imaging. X-ray yielded a sensitivity of 7.5% for rib fracture and 50% for pneumothorax with a specificity of 100% for both. Logistic regression analysis revealed no significant association between age, sex, bystander CPR, or resuscitation length with thoracic fractures or pneumothorax. Conclusions Complications from OHCA CPR were high with 29.2% of CT imaged patients having rib fractures and 8.8% having pneumothoraces. X-ray had poor sensitivity for these post-resuscitation complications. Post-CPR CT imaging of the chest should be considered for detecting post-CPR complications.
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Affiliation(s)
- Hashim Q Zaidi
- Section of Emergency Medicine, University of Chicago, Chicago, IL, USA
| | - Shu Li
- Department of Emergency Medicine, Peking University Third Hospital, Beijing, China
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, IL, USA
| | - Katie L Tataris
- Section of Emergency Medicine, University of Chicago, Chicago, IL, USA.,Chicago EMS System, Chicago, IL, USA
| | - Willard W Sharp
- Section of Emergency Medicine, University of Chicago, Chicago, IL, USA
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14
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Comparing thoracoabdominal injuries of manual versus load-distributing band cardiopulmonary resuscitation. Eur J Emerg Med 2021; 27:197-201. [PMID: 31714472 DOI: 10.1097/mej.0000000000000642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify and compare manual and load-distributing band (LDB) cardiopulmonary resuscitation (CPR)-related injuries. METHODS Retrospective observational cohort study. Adult, nontraumatic deaths with a postmortem computed tomography scan (PMCT) performed were classified into two groups: deceased after LDB CPR or after manual CPR. PMCT scans were reviewed for thoracoabdominal injuries such as fractures, pneumothorax and hemorrhage. The injuries between groups were compared. RESULTS LDB CPR (n = 43) showed increased incidences of posterior rib fractures (53 vs 18%, P = 0.006), pneumothorax (23 vs 4%, P = 0.04) and more pericardial fluid (median 12 vs 6 mm, P = 0.002) compared with manual CPR (n = 29). Multivariable regression analysis revealed that LDB CPR was significantly associated with posterior rib fractures [odds ratio (OR) 5.37, 95% confidence interval (CI): 1.44-20.09, P = 0.01). Pneumothorax (OR 6.80, 95% CI: 0.73-62.99, P = 0.09) and the amount of pericardial fluid (OR 3.40, 95% CI: 0.20-56.32) were not significantly associated with LDB CPR. No significant difference was found for anterolateral rib fractures, sternal fractures, vertebral fractures, pleural fluid, hemothorax, hemopericardium, pneumoperitoneum, perihepatic, perisplenic and perirenal hemorrhage. CONCLUSION Rib fractures, sternal fractures, hemothorax and hemopericardium are common CPR-related injuries. LDB CPR is significantly associated with more posterior rib fractures and a trend toward more pneumothoraces is observed when compared with manual CPR. This knowledge is important for caretakers in the case of ongoing CPR, as a pneumothorax may attribute to not achieving persistent return of spontaneous circulation, and to improve postresuscitation care of survivors.
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15
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Aging is only significant factor causing CPR-induced injuries and serious injuries. Leg Med (Tokyo) 2020; 48:101828. [PMID: 33370635 DOI: 10.1016/j.legalmed.2020.101828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) sometime cause severe injuries and can affect quality of life, lead to long-term disabilities or death of the patient. The aim of this study is to identify the risk factors causing CPR-induced injuries and those of serious injuries. METHODS This was a retrospective forensic autopsy study in a single institution. Among 885 forensic autopsies undertaken between 2011 and 2018, those in which the victim had undergone CPR immediately after cardiac arrest were recorded. 'Serious injuries' were defined as an Abbreviated Injury Scale (AIS) score ≥ 3. CPR-induced injuries were evaluated by three experienced forensic pathologists. With the background and history of the patient, the circumstances of cardiac arrest and risks of causing CPR-induced injuries were determined by multivariate analyses. RESULTS Seventy-five victims comprised the study cohort. CPR-induced injuries were found in 52 victims (69.3%). Rib fracture was the most common (60.0%), followed by sternal fracture (37.3%), heart injury (21.3%) and liver injury (8.0%). Multivariate analysis revealed higher age to be an independent factor causing CPR-induced injuries (odds ratio [OR], 1.07, P < 0.001). Thirty-six victims had 39 serious injuries in the chest or abdomen: fracture of ≥ 3 ribs (35 cases), aortic dissection (two), lung contusion (one) and rupture of the heart (one). Multivariate analysis revealed higher age to be an independent factor causing CPR-induced serious injuries (OR, 1.09; P < 0.001). CONCLUSION Aging was the significant factor causing CPR-induced injuries and serious injuries.
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16
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Hamanaka K, Nishiyama K, Nakamura M, Takaso M, Hitosugi M. Both Autopsy and Computed Tomography Are Necessary for Accurately Detecting Rib Fractures Due to Cardiopulmonary Resuscitation. Diagnostics (Basel) 2020; 10:diagnostics10090697. [PMID: 32942746 PMCID: PMC7556011 DOI: 10.3390/diagnostics10090697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022] Open
Abstract
Few studies have compared the sensitivities of autopsy and post mortem computed tomography (PMCT) in detecting rib fractures caused by cardiopulmonary resuscitation (CPR). We aimed to compare the characteristics between both modalities for accurately detecting CPR-related rib fractures. This single-centre observational study included adult patients with autopsy records and PMCT scans at our institution from January 2013 to March 2019. CPR-related rib fractures were evaluated using autopsy and PMCT findings. In 62 patients enrolled, 339 rib fractures were detected on autopsy and/or PMCT (222 fractures on both PMCT and autopsy, 69 on PMCT alone, and 50 on autopsy alone). The agreement of detection for both modalities was substantial (kappa coefficient, 0.78). In the logistic regression model, incomplete fractures detected by PMCT and age <75 years were significantly associated with findings that were negative on autopsy but positive on PMCT, while rib number (ribs 1–3 and 7–12) and fracture location (posterolateral and paravertebral) were significantly associated with negative PMCT findings but positive autopsy findings. Autopsy and PMCT showed complementary roles, and are thus necessary in accurately detecting CPR-related rib fractures. Combining both modalities may contribute to improved CPR quality and better understanding of discrepancy in characteristics between the two modalities.
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Affiliation(s)
- Kunio Hamanaka
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (M.N.); (M.T.); (M.H.)
- Department of Trauma and Critical Care, Kyoto Medical Center, Kyoto 612-8555, Japan;
- Correspondence: ; Tel.: +81-75-751-4399; Fax: +81-75-751-4255
| | - Kei Nishiyama
- Department of Trauma and Critical Care, Kyoto Medical Center, Kyoto 612-8555, Japan;
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (M.N.); (M.T.); (M.H.)
| | - Marin Takaso
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (M.N.); (M.T.); (M.H.)
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (M.N.); (M.T.); (M.H.)
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Friberg N, Schmidbauer S, Walther C, Englund E. Skeletal and soft tissue injuries after manual and mechanical chest compressions. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 5:259-265. [PMID: 30649242 DOI: 10.1093/ehjqcco/qcy062] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 11/12/2022]
Abstract
AIMS To determine the rate of injuries related to cardiopulmonary resuscitation (CPR) in cardiac arrest non-survivors, comparing manual CPR with CPR performed using the Lund University Cardiac Assist System (LUCAS). METHODS AND RESULTS We prospectively evaluated 414 deceased adult patients using focused, standardized post-mortem investigation in years 2005 through 2013. Skeletal and soft tissue injuries were noted, and soft tissue injuries were evaluated with respect to degree of severity. We found sternal fracture in 38%, rib fracture in 77%, and severe soft tissue injury in 1.9% of cases treated with CPR with manual chest compressions (n = 52). Treatment with LUCAS CPR (n = 362) was associated with significantly higher rates of sternal fracture (80% of cases), rib fracture (96%), and severe soft tissue injury (10%), including several cases of potentially life-threatening injuries. CONCLUSION LUCAS CPR causes significantly more CPR-related injuries than manual CPR, while providing no proven survival benefit on a population basis. We suggest judicious use of the LUCAS device for cardiac arrest.
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Affiliation(s)
- Niklas Friberg
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Medical Service, Clinical Genetics and Pathology, Sölvegatan 25, Lund, Sweden.,Department of Pediatrics, Skåne University Hospital, Lasarettsgatan 48, Lund, Sweden
| | - Simon Schmidbauer
- Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, Malmö, Sweden.,Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Carl Bertil Laurells gata 9, Malmö, Sweden.,Centre for Cardiac Arrest at Lund University, Lund University, Box 117, Lund, Sweden
| | - Charles Walther
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Medical Service, Clinical Genetics and Pathology, Sölvegatan 25, Lund, Sweden
| | - Elisabet Englund
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Medical Service, Clinical Genetics and Pathology, Sölvegatan 25, Lund, Sweden
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Sawyer KN, Camp-Rogers TR, Kotini-Shah P, Del Rios M, Gossip MR, Moitra VK, Haywood KL, Dougherty CM, Lubitz SA, Rabinstein AA, Rittenberger JC, Callaway CW, Abella BS, Geocadin RG, Kurz MC. Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e654-e685. [DOI: 10.1161/cir.0000000000000747] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process of care for patients who have had a cardiac arrest. As a result, the number of people surviving sudden cardiac arrest is increasing. However, physical, cognitive, and emotional effects of surviving cardiac arrest may linger for months or years. Systematic recommendations stop short of addressing partnerships needed to care for patients and caregivers after medical stabilization. This document expands the cardiac arrest resuscitation system of care to include patients, caregivers, and rehabilitative healthcare partnerships, which are central to cardiac arrest survivorship.
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20
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Gimpel D, Ni Leathlobhair N, Conway J, Magoye T, Macemon J, Macleod M, Nixey K, Odom N, McCormack DJ, Kejriwal N, Meikle F, El-Gamel A, Lin Z. External stabilisation with vacuum assisted contrivance (ES-VAC) for chest wall injuries sustained from cardiopulmonary resuscitation. Resuscitation 2019; 137:49-51. [PMID: 30735741 DOI: 10.1016/j.resuscitation.2019.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/02/2019] [Accepted: 01/19/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Damian Gimpel
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, New Zealand.
| | | | - Joseph Conway
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand
| | - Theresa Magoye
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand
| | - Jeff Macemon
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand
| | - Melanie Macleod
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand
| | - Karen Nixey
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand
| | - Nicholas Odom
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand
| | - David J McCormack
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Nand Kejriwal
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Felicity Meikle
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand
| | - Adam El-Gamel
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; National Institute of Demographic and Economic Analysis, The University of Waikato, New Zealand
| | - Zaw Lin
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand
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Chatzaraki V, Tappero C, Thali MJ, Schweitzer W. Death by hanging: a retrospective case-control investigation of the intervertebral disc vacuum phenomenon on PMCT. Forensic Sci Med Pathol 2018; 14:484-496. [PMID: 30426338 DOI: 10.1007/s12024-018-0034-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 01/30/2023]
Abstract
During hanging gravitational forces affect the spine. Intervertebral vacuum phenomenon (VP) implies that gas accumulations in the discs are caused by degeneration of the spine and trauma. It was hypothesized that VP detected on postmortem computed tomography (PMCT) has a higher incidence in hanging deaths, which can be correlated to age, degenerative spinal changes and type of hanging (complete-incomplete). Secondly, it was investigated whether the presence of Simon's bleedings is related to hanging type and VP on PMCT. A retrospective hanging case-control study of 72 cases was conducted. PMCT data were evaluated by two observers for the presence of VP and its localization within the thoracic and lumbar discs, and for any degenerative changes of the spine. Autopsy protocols were assessed for the presence of Simon's bleedings during autopsy. VP did not statistically differ among hanging and control cases but it was statistically correlated to complete hanging, increasing age and degenerative spinal changes. Centrally located VP within the discs was correlated to hanging, especially complete hanging, and younger ages, contrary to control cases that showed gas at the disc periphery. Simon's bleedings were correlated with complete hanging and centrally located VP. Centrally located VP within the discs increases the probability for complete hanging, while increasing age and degenerative changes reduce this probability. Intervertebral VP is multifactorial radiological entity. The presence of centrally located VP can indicate that hanging could be considered as an alternative mechanism of death and that great forces and loads may have affected the spine perimortem, especially with decreasing age and when Simon's bleedings are present.
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Affiliation(s)
- Vasiliki Chatzaraki
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
| | - Carlo Tappero
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland
| | - Michael J Thali
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Wolf Schweitzer
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
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Ondruschka B, Baier C, Bayer R, Hammer N, Dreßler J, Bernhard M. Chest compression-associated injuries in cardiac arrest patients treated with manual chest compressions versus automated chest compression devices (LUCAS II) - a forensic autopsy-based comparison. Forensic Sci Med Pathol 2018; 14:515-525. [PMID: 30203237 DOI: 10.1007/s12024-018-0024-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 12/18/2022]
Abstract
The aim of this autopsy study was to investigate chest-compression associated injuries to the trunk in out-of-hospital and in-hospital non-traumatic cardiac arrest patients treated with automated external chest compression devices (ACCD; all with LUCAS II devices) versus exclusive manual chest compressions (mCC). In this retrospective single-center study, all forensic autopsies between 2011 and 2017 were included. Injuries following cardiopulmonary resuscitation (CPR) in patients treated with mCC or ACCD were investigated and statistically compared using a bivariate logistic regression. In the seven-year period with 4433 autopsies, 614 were analyzed following CPR (mCC vs. ACCD: n = 501 vs. n = 113). The presence of any type of trunk injury was correlated with longer resuscitation intervals (30 ± 15 vs. 44 ± 25 min, p < 0.05). In comparison with mCC, treatment with ACCD led to more frequent skin emphysema (5 vs 0%, p = 0.012), pneumothorax (6 vs. 1%, p = 0.008), lung lesions (19 vs. 4%, p = 0.008), hemopericardium (3 vs 1%, p = 0.025) and liver lesions (10 vs. 1%, p = 0.001), all irrespective of confounding aspects. Higher age and longer CPR durations statistically influenced frequency of sternal and rib fractures (p < 0.001). The mean number of fractured ribs did not vary significantly between the groups (6 ± 3 vs. 7 ± 2, p = 0.09). In this cohort with unsuccessful CPR, chest compression-related injuries were more frequent following ACCD application than in the mCC group, but with only minutely increased odds ratios. The severity of injuries did not differ between the groups, and no iatrogenic injury was declared by the forensic pathologist as being fatal. In the clinical routine after successful return of spontaneous circulation a computed tomography scan for CPR-associated injuries is recommended as soon as possible.
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Affiliation(s)
| | - Christina Baier
- Institute of Legal Medicine, University of Leipzig, Leipzig, Germany
| | - Ronny Bayer
- Institute of Legal Medicine, University of Leipzig, Leipzig, Germany
| | - Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Jan Dreßler
- Institute of Legal Medicine, University of Leipzig, Leipzig, Germany
| | - Michael Bernhard
- Emergency Department, Heinrich Heine University, University Hospital, Duesseldorf, Germany
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