Cardiac rupture by penetration of fractured sternum: a rare complication of cardiopulmonary resuscitation

Machii, Masato; Inaba, Hideo; Nakae, Hajime; Suzuki, Ichirô; Tanaka, Hiroyuki

doi:10.1016/s0300-9572(99)00137-9

Cited by 55 publications

(32 citation statements)

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“…The risk of bystander CPR for patients not in cardiac arrest needs to be considered [35][36][37][38]. In this study, we did not determine how frequently telephone-CPR was attempted on patients who were not in cardiac arrest [39].…”

Section: Discussionmentioning

confidence: 97%

“…While tracheal intubation was not an independent factor associated with a favourable 1-Y survival, adrenaline administration was a potent independent factor related to unfavourable 1-Y survival. These effects of ACLS procedures were carefully interpreted because the procedures were performed only by specially trained paramedics in Japan.The risk of bystander CPR for patients not in cardiac arrest needs to be considered [35][36][37][38]. In this study, we did not determine how frequently telephone-CPR was attempted on patients who were not in cardiac arrest [39].…”

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confidence: 97%

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The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

et al. 2012

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(CQI) project for telephone-assisted cardiopulmonary resuscitation (telephone-CPR), which included instruction on chest-compression-only CPR, education on how to recognise out-of-hospital cardiac arrests (OHCAs) with agonal breathing, emesis and convulsion, recommendations for on-line or redialling instructions, and feedback from emergency physicians. This study aimed to investigate the effect of this project on the incidence of bystander CPR and the outcomes of OHCAs.Materials and Methods: The baseline data were prospectively collected on 4995 resuscitation-attempted OHCAs, which were recognised or witnessed by citizens rather than emergency medical technicians during the period of February 2004 to March 2010. The incidence of telephone-CPR and bystander CPR, as well as the outcomes of the OHCAs, were compared before and after the project.Results: The incidence of telephone-CPR and bystander CPR significantly increased after the project (from 42% to 62% and from 41% to 56%, respectively). The incidence of failed telephone-CPR due to human factors significantly decreased from 30% to 16%. The outcomes of OHCAs significantly improved after the projects. A multiple logistic regression analysis revealed that the CQI project is one of independent factors associated with one-year (1-Y) survival with favourable neurological outcomes (odds ratio = 1.81, 95% confidence interval = 1.20-2.76).Conclusions: The CQI project for telephone-CPR increased the incidence of bystander CPR and improved the outcome of OHCAs. A CQI project appeared to be essential to augment the effects of telephone-CPR.Keywords: Telephone-CPR; Continuous quality improvement; Cardiopulmonary resuscitation; Dispatcher; Emergency medical service; Out-of-hospital cardiac arrest INTRODUCTION Currently, medical control (MC) for the emergency medical service system (EMS) is active in Japan.However, MC, including education, is mainly targeted to emergency medical technicians (EMTs) and is rarely targeted to dispatchers in Japan. Since February 2004, the Ishikawa MC Council has requested that fire departments collect the reasons why dispatchers failed to provide telephone-assisted instruction on cardiopulmonary resuscitation (telephone-CPR). Telephone-CPR has been shown to increase the incidence of bystander CPR and is expected to improve the outcomes of out-of-hospital cardiac arrests (OHCAs) [1][2][3][4][5].There are no special qualifications or authorisations required for fire department staff to be dispatchers in Japan. Some dispatchers have no experience as EMTs. An educational program for dispatchers has not been established. In some fire departments, the actual condition of the OHCA patient, discovered by EMTs during a post-arrival interview, is not relayed back to the dispatchers.In March of 2007, the Ishikawa MC Council initiated the Continuous Quality Improvement (CQI) project for telephone-CPR. The project included the following: 1) a standardized manual for instruction on chest-compression-only CPR (CC-only CPR), 2) education on how to recognise OH...

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 97%

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

et al. 2012

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“…Resusitasyon sonucu olußan kÝrÝklar, pnšmotoraks veya i• organ rŸptŸrleri nedeniyle šlŸm ger•ekleßirse tÝbbi uygulama hatasÝ ßŸphesi doÛacaktÝr (10,21).…”

Section: Tartiþma Ve Sonu‚unclassified

“…Ancak tÝbbi mŸdahaleler sonucu ortaya •Ýkan lezyonlardan en fazla sorun olußturanlar, resusitasyon esnasÝnda meydana gelenlerdir. Resusitasyon ißlemleri sÝrasÝnda gerek hava yolu a•ÝlÝrken, gerekse kalp masajÝ uygulanÝrken ortaya •Ýkan ve kot kÝrÝklarÝndan, pnšmotoraks ve pnš-motestise uzanan •eßitlilikteki lezyonlarÝn, travmatik lezyonlardan ayÝrÝmÝ yanÝnda; kißinin šlŸm tarzÝnÝn ve zamanÝnÝn belirlenmesi de šnem kazanacaktÝr (3,(5)(6)(7)(8)(9)(10). …”

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Adli Otopsilerde Resusitasyon Artefaktları

Şam¹,

Saka²,

Süner³

2003

Bull Leg Med

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…ZETAcil tÝbbi mŸdahale uygulanmÝß otopsi olgularÝnda, travma bulgularÝnÝ yorumlamak gŸ•leßmekte, ortaya •Ýkan artefakt lezyonlarÝn šlŸme katkÝsÝnÝn olup olmadÝÛÝ tartÝßma konusu olabilmektedir.Bu •alÝßmada, ÜstanbulÕda Ocak 1998-Ocak 2002 tarihleri arasÝnda otopsisi yapÝlmÝß olgulara ait otopsi raporlarÝ, ayÝrÝm yapÝlmadan tek tek incelenmiß, resusitasyon sonucu meydana geldiÛine karar verilen lezyonlarÝn yeri ve niteliÛi ile ortaya •Ý-kan sorunlar, ilgili literatŸr bilgileri ÝßÝÛÝnda irdelenmißtir.OlgularÝn 51Õinde (%11.7) defibrilasyona baÛlÝ ekimozlu veya ekimozsuz kÝrÝklar, 19Õunda (%4.2) yalnÝzca ekimoz saptanmÝßtÝr. KÝrÝklarÝn en sÝk sol 3-4-5. kotlarda ve midklavikŸler hatta olußtuÛu, sternumda kÝrÝk gšrŸlme oranÝnÝn %33.33 olduÛu saptanmÝßtÝr. Bir•ok olguda pnšmotoraks testi yapÝlmamÝß olduÛu i•in pnšmotoraks olußma sÝklÝÛÝ kontrol edilememißtir.Anahtar kelimeler: Adli otopsi, kardiyopulmoner resusitasyon, artefakt lezyonlar, tÝbbi uygulama hatasÝ, sarsÝlmÝß bebek sendromu. SUMMARYDifferentiation of the antemortem, postmortem, artefactual and perimortem lesions secondary to medical interventions is a challenging task during the forensic autopsies.In this study, forensic autopsy records, performed in Istanbul between 1998-2002, were reviewed retrospectively and the cases with a resuscitation history and presenting lesions corresponding to the resuscitation were included. The location and the fetaures of the lesions, the problems arising from them were analyzed and discussed.11.7%(n:51) of resuscitated cases had multiple rib or sternum fractures with or without bruising and 4.2%(n:19) had only bruise. Fractures were found rarely on left 3.,4. and 5. ribs from mid-clavicular line. Sternum fractures were found, with or without bruising in 3.9%(n:17) of resuscitated cases.Key words: Forensic autopsy, CPR, artefactual lesions, malpractice, shaken baby syndrome. GÜRÜÞAdli otopsilerde; antemortem ve/veya postmortem olarak meydana gelmiß olan lezyonlar ile artefakt ßeklin-de ortaya •ÝkmÝß olan lezyonlarÝn yanÝnda, šzellikle canlÝlÝÛÝn son dšnemindeki tÝbbi mŸdahaleler esnasÝnda ortaya •Ýkan lezyonlarÝn ayÝrÝmÝ bŸyŸk šneme sahiptir (1-3).Otopsinin uygulanÝßÝ esnasÝnda daha šnceden tÝbbi mŸdahaleler, šzellikle de cerrahi girißimler sonucu meydana gelen lezyonlarÝn, kißide mevcut olan veya olmasÝ muhtemel travmatik lezyonlardan ayÝrÝmÝnda, bazen gŸ•lŸkler yaßanabilmekte, hatta kesin ayÝrÝm i•in kißiye ait tÝbbi belgelerin incelenmesi gerekebilmektedir (1,2,4). Ancak tÝbbi mŸdahaleler sonucu ortaya •Ýkan lezyonlardan en fazla sorun olußturanlar, resusitasyon esnasÝnda meydana gelenlerdir. Resusitasyon ißlemleri sÝrasÝnda gerek hava yolu a•ÝlÝrken, gerekse kalp masajÝ uygulanÝrken ortaya •Ýkan ve kot kÝrÝklarÝndan, pnšmotoraks ve pnš-motestise uzanan •eßitlilikteki lezyonlarÝn, travmatik lezyonlardan ayÝrÝmÝ yanÝnda; kißinin šlŸm tarzÝnÝn ve zamanÝnÝn belirlenmesi de šnem kazanacaktÝr (3,(5)(6)(7)(8)(9)(10).

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“…Rarer complications include tracheal injury, gastric rupture or injury to solid organs (liver and spleen). 1,2 In this study, two cases of liver injury caused by resuscitation have been presented and the subject has been discussed in the light of actual literature.…”

Section: Introductionmentioning

confidence: 99%

Liver laceration related to cardiopulmonary resuscitation.

Beydilli¹

2015

Tr J Emerg Med

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a b s t r a c tCardiopulmonary resuscitation (CPR) is recognized as a medical procedure performed to maintain vital functions of a person whose cardiac and respiratory functions have stopped. Chest compression is the most essential component of CPR and it is performed on the lower half of the sternum. During CPR, many complications may occur because of chest compressions, especially chest injuries including sternum and rib fractures. Rarely tracheal injury, rupture of the stomach, or liver or spleen injury may also occur as complications.In this study, we present two cases of liver injury caused by resuscitation. With this article, we want to emphasize the importance of making correct chest compressions.

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Cardiac rupture by penetration of fractured sternum: a rare complication of cardiopulmonary resuscitation

Cited by 55 publications

References 6 publications

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

Adli Otopsilerde Resusitasyon Artefaktları

Liver laceration related to cardiopulmonary resuscitation.

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