Abstract
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.
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References
Agdal N, Jorgensen TG (1973) Penetrating laceration of the pericardium and myocardium and myocardial rupture following closed-chest cardiac massage. Acta Med Scand 194:477–479
American Heart Association (1992) Adult basic life support. JAMA 268:2171–2298
Atcheson SG, Fred HL (1975) Complications of cardiac resuscitation. Am Heart J 89:263–265
Bodily K, Fischer RP (1979) Aortic rupture and right ventricular rupture induced by closed-chest cardiac massage. Minn Med 62:225–227
Bynum WR, Connell RM, Hawk WA (1963) Causes of death after external cardiac massage. Cleve Clin Q 30:147–151
Clark DT (1962) Complications following closed-chest cardiac massage. JAMA 181:337–338
Cohen TJ, Goldner BG, Maccaro PC, Ardito AP, Trazzera S, Cohen MB, Dibs SR (1993) A comparison of active compressiondecompression cardiopulmonary resuscitation with standard cardiopulmonary resuscitation for cardiac arrests occurring in the hospital. N Engl J Med 329:1918–1921
Cohn LH, Sayer WJ (1963) Multiple complications from external cardiac massage. Calif Med 98:220–221
Cowan D (1966) Pancreatitis and pulmonary hemorrhage complicating closed-chest cardiac massage. Can Med Assoc J 95:976–977
European Resuscitation Council. Basic life support working party (1992) Guidelines for basic life support. Resuscitation 24:103–110
Fosse E, Lindberg H (1996) Left ventricular rupture following external chest compression. Acta Anaesthesiol Scand 40:502–504
Frey R, Kolb E, Henneberg U (1964) Gefahren der dusseren Herzwiederbelebung. Dtsch Med Wochenschr 89:630–634
Henriksen H (1967) Rib fractures following external cardiac massage. Acta Anaesthesiol Scand 11:57–64
Lignitz E, Mattig W (1989) Die kardiale Reanimation. In: Lignitz E, Mattig W (eds) Der iatrogene Schaden. Akademie, Berlin, pp 102–118
Lurie KG, Lindo C, Chin J (1990) CPR: the ‘P’ stands for plumber's helper. JAMA 264:1661
Lurie KG, Shultz JJ, Callaham ML, Schwab TM, Gisch T, Rector T, Frascone RJ, Long L (1994) Evaluation of active compression-decompression CPR in victims of out-of-hospital cardiac arrest. JAMA 271:1405–1411
Moe N (1967) Complications following resuscitation. Acta Med Scand 182:773–779
Noffsinger AE, Blisard KS, Balko MG (1991) Cardiac laceration and pericardial tamponade due to cardiopulmonary resuscitation after myocardial infarction. J Forensic Sci 36:1760–1764
Paaske F, Hart Hansen JP, Koudahl G, Olsen J (1968) Complications of closed-chest cardiac massage in a forensic autopsy material. Dan Med Bull 15:225–230
Powner DJ, Holcombe PA, Mello LA (1984) Cardiopulmonary resuscitation-related injuries. Crit Care Med 12:54–55
Saternus KS (1981) Direkte und indirekte Traumatisierung bei der Reanimation. Z Rechtsmed 86:161–174
Saukko P (1980) Gerichtsmedizinische Gesichtspunkte für die Beurteilung von Schäden nach der äusseren Herzmassage. Zentralbl Rechtsmed 20:8
Schroeder J, Stevens JS (1993) CPR-induced rib fractures. Characteristic scintigraphic appearance. Clin Nucl Med 18:717
Schwab TM, Callaham ML, Madsen CD, Utecht TA (1995) A randomized clinical trial of ACD-CPR vs standard CPR in out-ofhospital cardiac arrest in two cities. JAMA 273:1261–1268
Shultz JJ, Coffeen P, Sweeney M, Detloff B, Kehler C, Pineda E, Yakshe P, Adler SW, Chang M, Lurie KG (1994) Evaluation of standard and active compression-decompression CPR in an acute human model of ventricular fibrillation. Circulation 89:684–693
Silberberg B, Rachmaninoff N (1964) Complications following external cardiac massage. Surg Gynecol Obstet 119:6–10
Tucker KJ, Galli F, Savitt MA, Kahsai D, Bresnahan L, Redberg RF (1994) Active compression-decompression resuscitation: effect on resuscitation success after in-hospital cardiac arrest. J Am Coll Cardiol 24:201–209
Wik L, Mauer D, Robertson C (1995) The first European pre-hospital cardiopulmonary resuscitation workshop: a report and a review of ACD-CPR. Resuscitation 30:191–202
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Rabt, W., Broinger, G., Scheithauer, R. et al. Serious complications from active compression-decompression cardiopulmonary resuscitation. Int J Leg Med 109, 84–89 (1996). https://doi.org/10.1007/BF01355522
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DOI: https://doi.org/10.1007/BF01355522