Elsevier

Resuscitation

Volume 85, Issue 12, December 2014, Pages 1708-1712
Resuscitation

Clinical paper
CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device: A multicentre study of victims after unsuccessful resuscitation

https://doi.org/10.1016/j.resuscitation.2014.09.017Get rights and content

Abstract

Aim

The reported incidence of injuries due to cardiopulmonary resuscitation using manual chest compressions (manual CPR) varies greatly. Our aim was to elucidate the incidence of CPR-related injuries by manual chest compressions compared to mechanical chest compressions with the LUCAS device (mechanical CPR) in non-survivors after out-of-hospital cardiac arrest.

Methods

In this prospective multicentre trial, including 222 patients (83 manual CPR/139 mechanical CPR), autopsies were conducted after unsuccessful CPR and the results were evaluated according to a specified protocol.

Results

Among the patients included, 75.9% in the manual CPR group and 91.4% in the mechanical CPR group (p = 0.002) displayed CPR-related injuries. Sternal fractures were present in 54.2% of the patients in the manual CPR group and in 58.3% in the mechanical CPR group (p = 0.56). Of the patients in the manual CPR group, there were 64.6% with at least one rib fracture versus 78.8% in the mechanical CPR group (p = 0.02). The median number of rib fractures among patients with rib fractures was 7 in the manual CPR group and 6 in the mechanical CPR group. No CPR-related injury was considered to be the cause of death.

Conclusion

In patients with unsuccessful CPR after out-of-hospital cardiac arrest, rib fractures were more frequent after mechanical CPR but there was no difference in the incidence of sternal fractures. No injury was deemed fatal by the pathologist.

Introduction

Cardiopulmonary resuscitation (CPR) is a desperate, potentially life-saving measure to regain spontaneous circulation. Subsequent reports about injuries due to CPR have not changed the way it has been performed.1, 2, 3, 4, 5 The use of mechanical devices in CPR has been linked to a higher incidence of injuries compared to standard CPR with manual chest compressions (manual CPR).6, 7, 8 The LUCAS™ device, which delivered mechanical chest compressions (mechanical CPR), was introduced in 2002. Indications of injuries associated with the device's use revealed the need for further studies looking into its safety.9, 10 Preliminary data from two as yet unpublished studies had diverging results and a pilot study revealed no difference in incidence of injuries between the two methods of chest compressions in CPR.11, 12, 13 Therefore, we conducted a multicentre autopsy trial and hypothesised that there would be no difference in CPR-related injuries by manual chest compressions compared to mechanical chest compressions with the LUCAS™ device in patients after unsuccessful resuscitation from out-of-hospital cardiac arrest.

Section snippets

Materials and methods

This prospective multicentre study, with fixed dates from January 15, 2008 to August 31, 2012, was reviewed and approved by the human ethics committee in Uppsala, Sweden. This committee waived the need for informed consent.

Results

Of the 222 patients included, 83 patients (37.4%) had been treated with manual CPR only and 139 patients (62.6%) with mechanical CPR including manual CPR prior to mechanical CPR. There was no difference in age, gender or duration of CPR by EMS personnel between the two groups and there was no correlation between the two latter parameters and the incidence of rib or sternal fractures.

In the patients receiving mechanical CPR, the average duration of initial manual chest compressions by EMS

Discussion

In this prospective multicentre autopsy trial comprising patients with unsuccessful CPR, chest compression-related injuries were more common in patients after mechanical CPR than manual CPR. There were more patients with rib fractures due to mechanical CPR but the median numbers of rib fractures were equal in both groups. There was also no difference in the number of multiple rib fractures or sternal fractures.

In this study, sternal fractures were more frequent than shown before (1.3–43.3%) and

Conclusions

In patients with unsuccessful CPR after out-of-hospital cardiac arrest, rib fractures were more frequent after mechanical CPR but there was no difference in the incidence of sternal fractures. No injury was deemed fatal by the pathologist.

Conflict of interest statement

The authors David Smekal, Erik Lindgren, Håkan Sandler and Jakob Johansson declare no conflict of interest. Sten Rubertsson was the PI for the LINC trial and has done some consultant work for Physiocontrol/Jolife AB.

Acknowledgements

We would like to express gratitude to EMS personnel performing CPR and the pathologists and autopsy technicians at the different sites. A personal research grant was given to David Smekal by the Uppsala-Örebro Regional Research Council in Sweden (RFR-212911).

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.09.017.

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