A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries

Miller, Andrew C.; Rosati, Shannon F.; Suffredini, Anthony F.; Schrump, David S.

doi:10.1016/j.resuscitation.2014.01.028

Cited by 141 publications

(134 citation statements)

References 81 publications

(114 reference statements)

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“…Miller et al 5 compared standard CPR methodology (chest compressions using the hands only) with CPR, using active compression devices (ACDs) employing either suction cup, automated piston, or load-distributing band technologies. Their findings showed that sternal and rib fracture rates, respectively, were 8.5% and 25.9% in manual compression, 80.6% and 47.2% for suction cup ACD, and 16.9% and 25.4% for piston ACD.…”

Section: Cjem Jcmumentioning

confidence: 99%

“…Similarly, in a review of 2659 autopsy cases, only three incidences of right ventricular rupture secondary to CPR were identified. 6 Last, two comprehensive meta-analyses of CPRassociated injuries found myocardial rupture in only 5 of 818 (0.6%) 5 and <1% of cases. Resuscitation-associated myocardial injury has been observed in a number of clinical settings, including cases of acute myocardial infarction, 8 broken ribs, 6,9 multiple large pulmonary emboli, 10 and recent lung and pericardial surgery.…”

Section: Cjem Jcmumentioning

confidence: 99%

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CPR-associated right ventricular rupture in the setting of pulmonary embolism

Hickey

Gill

Seidman

et al. 2016

CJEM

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Cardiopulmonary resuscitation (CPR) is an inherently traumatic procedure. Successful resuscitations are often complicated by iatrogenic injuries to structures of the neck, thorax, or abdomen. Rib and sternal fractures are the most frequently induced injuries. However, rare and life-threatening trauma to vital organs such as the heart may also occur during CPR. We describe a novel case of CPR-associated right ventricular rupture in a woman with acute-on-chronic pulmonary embolism and no known pre-existing cardiac disease. We propose that chest compressions in the setting of elevated right ventricular pressure resulted in cardiac rupture, in this case. RÉSUMÉLa réanimation cardiorespiratoire (RCR) est en ellemême une manoeuvre traumatique. Les réanimations couronnées de succès se compliquent souvent de lésions iatrogènes aux structures du cou, du thorax ou de l'abdomen. Les fractures de côtes ou du sternum sont les lésions les plus fréquentes attribuables à la RCR. Toutefois, il peut arriver que des traumas extrêmement graves soient causés à des organes vitaux comme le coeur, mais le phénomène est rare. Sera exposé ici un nouveau cas de rupture du ventricule droit, associée à la RCR chez une femme ayant subi une embolie pulmonaire aiguë accompagnée de signes chroniques, mais ne souffrant pas d'une maladie cardiaque préexistante connue. Aussi sommes-nous d'avis que les compressions thoraciques effectuées dans le contexte d'une pression ventriculaire droite élevée se sont soldées par la rupture de la structure cardiaque.Keywords: autopsy, resuscitation, cardiac injury, iatrogenic, pulmonary embolism CASE REPORTA 79-year-old woman with osteoporosis, dyslipidemia, and 1 year of unexplained weight loss (less than 30 lb) was on her way to see her family physician. She had booked the appointment because she had been feeling generally unwell and fatigued for several weeks-her condition worsening in recent days. She collapsed in her residential driveway, and paramedics attended to her within 10 minutes. At the scene, she was pulseless with agonaltype respirations, and the paramedics initiated CPR. On arrival at the local emergency department, the patient had a Glasgow Coma Scale of 3 and vital signs were absent. In the hospital, the patient received continued standard resuscitative efforts, including chest compressions, four external cardiac defibrillation attempts, oxygen delivery via bag-valve-mask and boluses of epinephrine, calcium, and bicarbonate. Chest compressions resulted in rib fractures and an unusual swelling of the right neck. The patient never achieved return of spontaneous circulation, and the health care providers ceased resuscitation efforts after 25 minutes of standard total CPR protocol.A postmortem examination was requested to determine the cause of death. On opening the thorax, extensive blood was present throughout the soft tissues

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Section: Cjem Jcmumentioning

confidence: 99%

Section: Cjem Jcmumentioning

confidence: 99%

CPR-associated right ventricular rupture in the setting of pulmonary embolism

Hickey

Gill

Seidman

et al. 2016

CJEM

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“…In addition, even brief external compressions can pose significant risks of cardiac damage shortly after heart surgery, as noted in multiple case reports of massive hemorrhage subsequent to CPR in these patients. 7,8 A recent meta-analysis 9 in noncardiac surgery patients receiving ECC identified a high rate of complications, including pericardial injury (8.9%), fractured sternum (15%), and rib fractures (32%), as well as additional Given the potential for harm from even brief compressions, it is reasonable to defer ECC momentarily for more definitive therapies, as long as they are timely:…”

Section: Cardiopulmonary Resuscitationmentioning

confidence: 99%

Standards for Resuscitation After Cardiac Surgery

Ley

2015

Critical Care Nurse

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Of the 250 000 patients who undergo major cardiac operations in the United States annually, 0.7% to 2.9% will experience a postoperative cardiac arrest. Although Advanced Cardiac Life Support (ACLS) is the standard approach to management of cardiac arrest in the United States, it has significant limitations in these patients. The European Resuscitation Council (ERC) has endorsed a new guideline specific to resuscitation after cardiac surgery that advises important, evidence-based deviations from ACLS and is under consideration in the United States. The ACLS and ERC recommendations for resuscitation of these patients are contrasted on the basis of the essential components of care. Key to this approach is the rapid elimination of reversible causes of arrest, followed by either defibrillation or pacing (as appropriate) before external cardiac compressions that can damage the sternotomy, cautious use of epinephrine owing to potential rebound hypertension, and prompt resternotomy (within 5 minutes) to promote optimal cerebral perfusion with internal massage, if prior interventions are unsuccessful. These techniques are relatively simple, reproducible, and easily mastered in Cardiac Surgical Unit–Advanced Life Support courses. Resuscitation of patients after heart surgery presents a unique opportunity to achieve high survival rates with key modifications to ACLS that warrant adoption in the United States.

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“…The most common CPR related injuries are located on the thorax and affect especially the skeleton: rib fractures, fractures of the sternum (3,7) and flail chest (7). Nevertheless, in children, whose thoracic cage is still quite elastic, bone injuries are rarely reported -0-2% [9].…”

Section: öZetmentioning

confidence: 99%

Considerations on Liver Injuries Caused by CPR Case Presentation

Ioan¹,

Hanganu²,

Neagu³

2015

Bull Leg Med

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Cardiac arrest is a life-threatening condition which requires fast maneuvers for saving the victim's life. Cardio-pulmonary resuscitation (CPR) is one of the easiest and handiest maneuver which proved many times to be savior even though sometimes it could worsen the victim's prognosis. In this paper the authors present the case of a 75-year old male, with a significant medical history and long term thrombolytic treatment who suffered a witnessed cardiac arrest. The emergency team who arrived at the victim's home initiated the CPR and transported him to the hospital. The electrocardiogram showed inferior-lateral acute myocardial infarction and the cardiologist in the emergency room decided to transfer him to another hospital for specialized treatment. Despite the fact that the CPR was continued in the ambulance in order to maintain the cardiac activity, the blood pressure decreased gradually and he died couple of hours later. Internal examination at the autospy revealed multiple injuries caused by the cardiac massage: rib and sternum fractures, massive intraperitoneal bleeding, liver laceration and contusion. This paper brings to the attention of the physicians the issue of the iatrogenic injuries following the CPR and the possibility for these injuries to contribute to thanatogenesis. The authors also analyze the factors influencing the quality of the life-saving procedures and the role of the pathologist in establishing the correct cause of death taking into the gravity of the CPR related injuries.

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A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries

Cited by 141 publications

References 81 publications

CPR-associated right ventricular rupture in the setting of pulmonary embolism

CPR-associated right ventricular rupture in the setting of pulmonary embolism

Standards for Resuscitation After Cardiac Surgery

Considerations on Liver Injuries Caused by CPR Case Presentation

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