Elsevier

Resuscitation

Volume 88, March 2015, Pages 86-91
Resuscitation

Clinical paper
Computed tomography findings of complications resulting from cardiopulmonary resuscitation

https://doi.org/10.1016/j.resuscitation.2014.12.022Get rights and content

Abstract

Introduction

This retrospective study was conducted to evaluate injuries related to cardiopulmonary resuscitation (CPR) and their associated factors using postmortem computed tomography (PMCT) and whole body CT after successful resuscitation.

Methods

The inclusion criteria were adult, non-traumatic, out-of-hospital cardiac arrest patients who were transported to our emergency room between April 1, 2008 and March 31, 2013. Following CPR, PMCT was performed in patients who died without return of spontaneous circulation (ROSC). Similarly, CT scans were performed in patients who were successfully resuscitated within 72 h after ROSC. The injuries associated with CPR were analysed retrospectively on CT images.

Results

During the study period, 309 patients who suffered out-of hospital cardiac arrest were transported to our emergency room and received CPR; 223 were enrolled in the study.

The CT images showed that 156 patients (70.0%) had rib fractures, and 18 patients (8.1%) had sternal fractures. Rib fractures were associated with older age (78.0 years vs. 66.0 years, p < 0.01), longer duration of CPR (41 min vs. 33 min, p < 0.01), and lower rate of ROSC (26.3% vs. 55.3%, p < 0.01). All sternal fractures occurred with rib fractures and were associated with a greater number of rib fractures, higher age, and a lower rate of ROSC than rib fractures only cases. Bilateral pneumothorax was observed in two patients with rib fractures.

Conclusions

PMCT is useful for evaluating complications related to chest compression. Further investigations with PMCT are needed to reduce complications and improve the quality of CPR.

Introduction

Chest compression has been the most important component of cardiopulmonary resuscitation (CPR) since the 1960s 1, 2. However, there are complications related to chest compression, such as rib and sternal fractures. While rare, fatal lacerations and haemorrhage of intra-abdominal or intra-thoracic organs can occur 3. Although there have been many studies of the incidence of or factors related to complications of CPR, most of them are relatively old and based on autopsy or X-ray findings. In addition, the guidelines for CPR have been changing to involve quicker and deeper chest compression 4, 5. Except in some large urban areas, autopsies are rarely performed in Japan for patients unsuccessfully resuscitated by CPR on arrival at hospital. Postmortem computed tomography (PMCT) as a form of autopsy imaging has disseminated widely in Japanese tertiary care centres to investigate and identify the cause of death. To date, there have been no studies investigating the overall incidence of complications resulting from CPR regardless of resuscitation outcome using both PMCT and postresuscitation CT.

Section snippets

Methods

After receiving the approval of the Ethics Committee of Asahikawa Medical University, Hokkaido, Japan (Approval no: 1751), a retrospective study was conducted. The inclusion criteria were adult, non-traumatic, out-of hospital cardiac arrest patients who were transported to our emergency department between April 1, 2008 and March 31, 2013. Mechanical chest compression devices were not used in pre-hospital care and in the emergency department. The exclusion criteria were patients who had a

Results

During the study period, 309 patients with out-of-hospital cardiac arrest were transported to our emergency department and received CPR; 85 patients were excluded because they did not undergo CT (or underwent only head CT) (n = 72), were under the age of 18 years (n = 6), or had traumatic cardiac arrest (n = 8). Most of the patients who did not undergo PMCT were transported to our emergency department in 2008. At that time, PMCT was in the early period of introduction in our hospital. Therefore, not

Discussion

This is the first comprehensive study based on both PMCT and postresuscitation CT images of complications associated with chest compression regardless of patients’ outcome after CPR. The present study showed that almost 70% of patients had rib fractures, which were related to older age, longer duration of CPR, and a lower rate of ROSC. As Kim et al. 7 and Baubin et al. 8 stated, most rib fractures were located in the anterolateral area of the thoracic cage. Additionally, in the rib fracture

Conclusion

PMCT is useful for evaluating complications related to chest compression. Further investigations with PMCT are needed to reduce complications and to improve the quality of CPR, especially the methods of chest compression.

Conflict of interest statement

The authors declare that they have no competing interests.

Role of funding source

None.

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2014.12.022.

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