Elsevier

Resuscitation

Volume 80, Issue 10, October 2009, Pages 1104-1107
Resuscitation

Clinical paper
No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS™ device—A pilot study

https://doi.org/10.1016/j.resuscitation.2009.06.010Get rights and content

Abstract

Aim

To compare the variety and incidence of internal injuries after manual and mechanical chest compressions during CPR.

Methods

In a prospective pilot study conducted in two Swedish cities, 85 patients underwent autopsy after unsuccessful resuscitation attempts with manual or mechanical chest compressions, the latter with the LUCAS™ device. Autopsy was performed and the results were evaluated according to a specified protocol.

Results

No injuries were found in 26/47 patients in the manual group and in 16/38 patients in the LUCAS group (p = 0.28). Sternal fracture was present in 10/47 in the manual group and 11/38 in the LUCAS group (p = 0.46), and there were multiple rib fractures (≥3 fractures) in 13/47 in the manual group and in 17/38 in the LUCAS group (p = 0.12). Bleeding in the ventral mediastinum was noted in 2/47 and 3/38 in the manual and LUCAS groups respectively (p = 0.65), retrosternal bleeding in 1/47 and 3/38 (p = 0.32), epicardial bleeding in 1/47 and 4/38 (p = 0.17), and haemopericardium in 4/47 and 3/38 (p = 1.0) respectively. One patient in the LUCAS group had a small rift in the liver and one patient in the manual group had a rift in the spleen. These injuries were not considered to have contributed to the patient's death.

Conclusion

Mechanical chest compressions with the LUCAS™ device appear to be associated with the same variety and incidence of injuries as manual chest compressions.

Introduction

In 2005, the European Resuscitation Council (ERC) and the American Heart Association revised the guidelines for resuscitation, which resulted in increased focus on the importance of chest compressions.1 A new algorithm was constructed to reduce the hands-off interval and possibly improve the quality of cardiopulmonary resuscitation (CPR). During resuscitation, chest compressions are only performed for about 50% of the time and the majority of the compressions are too shallow.2 In addition, at best manual chest compressions only achieve a cardiac output of approximately 20–30% of the normal,3, 4, 5 and owing to fatigue the quality of the compressions decreases after a few minutes.6 Also, it is difficult to perform high quality CPR during transport.7 This supports the need for a mechanical device that will improve the delivery of chest compressions. In 1908, a mechanical device was developed to deliver external chest compressions,8 and up until the 1990s several different devices were produced, but with poor results.9, 10 In 2002, a new device called LUCAS™ was marketed, and this appears to have improved vital organ blood flow in experimental studies.11, 12

Internal injuries after manual and mechanical chest compressions are common and the most frequently reported complications of CPR are skeletal injuries, especially to ribs and the sternum.13 Furthermore, complications from the upper airway, lungs, heart, and great vessels, and injuries to the gastrointestinal system, including laceration of the liver or spleen and retroperitoneal haemorrhage, have been reported to occur with varying frequencies.13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 Recently there have been discussions regarding a postulated increase in the frequency and severity of internal injuries after mechanical chest compressions during CPR. However, these discussions have often been based upon case reports or undersized studies.30 Only a few studies highlight the adverse effects of both manual and mechanical CPR.22, 31, 32

The aim of this study was to compare the variety and incidence of internal injuries, as assessed by autopsy, after manual and mechanical chest compressions during CPR. It was hypothesised that there is no difference in the incidence of injuries after manual chest compressions during CPR compared with that after mechanical chest compressions with the LUCAS™ device.

Section snippets

Study population and design

The study was reviewed and approved by the human ethics committee in Uppsala, Sweden. This committee waived the need for informed consent. In this prospective pilot study, conducted from February 1st 2005 to April 1st 2007, patients not surviving cardiac arrest at Uppsala University Hospital and Gävle County Hospital, Sweden, underwent autopsy based upon a decision taken by the admitting physician. Swedish law regulates the possibility of autopsy, and briefly, the relatives’ view determines

Results

Of the 85 patients included, 47 (55%) received manual CPR and 38 (45%) were treated with the LUCAS™ device. There was no difference in age, sex or duration of CPR by EMS personnel between the two groups and there was no correlation between these parameters and the incidence of rib and sternal fractures. Demographic data of the patients included are presented in Table 1.

In the LUCAS group, the average duration of initial manual compression was 2.9 ± 2.1 min before the LUCAS™ device was started.

Discussion

In this prospective autopsy study on cardiac arrest victims no difference was found in the variety and incidence of internal injuries after mechanical chest compressions with the LUCAS™ device compared with those after manual chest compressions. There were fractures, soft tissue injuries, and injuries to inner organs that were classified as consequences of chest compressions. However, none of these injuries was considered to be a contributory factor in the patient's death, according to the

Conclusion

Mechanical chest compressions with the LUCAS™ device result in the same variety and incidence of injuries as do manual chest compressions during CPR. The LUCAS™ device does not seem to carry an added risk for life-threatening injuries and if proven effective it could be used safely in accordance with ERC guidelines. To secure validity, the findings need to be challenged in a larger prospective study.

Conflicts of interest

The authors David Smekal, Jakob Johansson and Tibor Huzevka declare no conflict of interest. Sten Rubertsson has performed consultant work for Jolife AB.

Acknowledgments

The authors wish to express their gratitude to the pathologists at the Department of Pathology and Cytology at Uppsala and Gävle hospitals, Sweden, the Department of Forensic Medicine in Uppsala, Sweden, and EMS personnel in Uppsala and Gävle, Sweden. We also wish to thank Lars Berglund and Karin Jensevik, biostatisticians at the Uppsala Clinical Research Centre (UCR), for their help with the evaluation of the statistics.

This study has been supported by an institutional grant from Uppsala

References (38)

Cited by (112)

  • Safety of mechanical and manual chest compressions in cardiac arrest patients: A systematic review and meta-analysis

    2021, Resuscitation
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    In contrast, no noteworthy discrepancies were identified between the AutoPulse and manual compression groups (OR, 2.08; 95% CI, 0.81–5.36; I2, 0.00%) (Fig. 6). Eight16,25–27,35–37,39 of the studies included reported the rate of lung lesions (seven16,25,26,35–37,39 of which compared LUCAS with manual CPR, and one27 evaluated LUCAS vs. AutoPulse vs. manual compressions). No differences were apparent between mechanical and manual methods (OR, 1.94; 95% CI, 0.83–4.56; I2, 68.94%) (Fig. 7).

  • Characteristics of mechanical CPR-related injuries: A case series

    2020, Journal of Forensic and Legal Medicine
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    Several studies both concerning only manual-CPR and manual prior to mech-CPR report no association between the duration of chest compression and the occurrence of injuries.6,7,19–21 Some researchers have associated the injuries following CPR to peak levels of energy at first compression, thus describing the injuries as occurring within the first minutes of CPR,6,20 but this has recently been challenged by four research groups, including our own.11,15,17,22 Boland et al. investigated injuries detected by diagnostic imaging in cardiac arrest survivors treated with mech-CPR and ascribes a higher prevalence of injuries in the mech-CPR group to an extended period of chest compression.17

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.06.010.

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