Comparison of complications secondary to cardiopulmonary resuscitation between out-of-hospital cardiac arrest and in-hospital cardiac arrest

Seung, Min Kyung; Park, Y

doi:10.1186/cc14499

Cited by 3 publications

(3 citation statements)

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“…Risk factors for CPR-related injuries include depth of chest compression, advanced age, prolonged CPR, and OHCA. 3–7 Moreover, the rate of CPR-related injuries has been found to increase with age and CPR duration. 4,5 A recent autopsy study found that older age, male sex, and administration of CPR in a public place were associated with CPR-related injuries, with the higher rates of CPR-related injuries in elderly patients being attributed to age-related osteoporosis, tissue stiffness, and degenerative skeletal changes.…”

Section: Discussionmentioning

confidence: 99%

“…3–7 Moreover, the rate of CPR-related injuries has been found to increase with age and CPR duration. 4,5 A recent autopsy study found that older age, male sex, and administration of CPR in a public place were associated with CPR-related injuries, with the higher rates of CPR-related injuries in elderly patients being attributed to age-related osteoporosis, tissue stiffness, and degenerative skeletal changes. 6 Abnormal hand positions and compression pressure during ambulance transport 4 and more intense chest compressions due to the stress of performing CPR in a public place 6 may result in high rates of complications in patients who experience OHCA.…”

Section: Discussionmentioning

confidence: 99%

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Diaphragmatic rupture and massive pneumoperitoneum after cardiopulmonary resuscitation

Lee

Sung

2023

Hong Kong j. emerg. med.

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Introduction: Although cardiopulmonary resuscitation is an emergency life-saving procedure, the intervention itself can cause major and often fatal injuries, with diaphragmatic rupture being very rare. This report describes a patient who experienced bilateral pneumothoraces, left diaphragmatic rupture, and pneumoperitoneum after extended cardiopulmonary resuscitation. Case presentation: A 90-year-old woman experienced a cardiac arrest. Spontaneous circulation was restored after 49 min of cardiopulmonary resuscitation performed by a bystander, emergency medical service providers, and emergency department staff. Imaging showed bilateral pneumothoraces, left diaphragmatic rupture, and massive pneumoperitoneum. The patient’s guardian refused to permit surgery for the diaphragmatic rupture, and the patient died despite chest and abdominal decompression and post-cardiac arrest care. Discussion and conclusion: Procedures to restore spontaneous circulation in patients experiencing cardiac arrest may result in fatal cardiopulmonary resuscitation–related injuries. Clinicians providing post-cardiac arrest care should plan management for these iatrogenic injuries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diaphragmatic rupture and massive pneumoperitoneum after cardiopulmonary resuscitation

Lee

Sung

2023

Hong Kong j. emerg. med.

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“…Chest compressions as part of cardiopulmonary resuscitation (CPR) for sudden cardiac arrest are vital in providing oxygenated blood to the heart and brain, but are also traumatic 1–3 . Rib fractures are the most common chest wall injuries following CPR and seen in 66% to 88% of patients who survived sudden cardiac arrest 4–8 . Various studies have associated sustaining posttraumatic rib fractures, an increasing number of rib fractures, and fracture displacement over half the ribs' width as risk factors for mortality and pulmonary complications including pneumonia 9–14 .…”

mentioning

confidence: 99%

Surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures following cardiopulmonary resuscitation: an international, retrospective matched case-control study (CWIS-CPR)

Prins

Lieshout

Eriksson

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:The presence of six or more rib fractures or a displaced rib fracture due to cardiopulmonary resuscitation (CPR) has been associated with longer hospital and intensive care unit (ICU) length of stay (LOS). Evidence on the effect of surgical stabilization of rib fractures (SSRF) following CPR is limited. This study aimed to evaluate outcomes after SSRF versus nonoperative management in patients with multiple rib fractures after CPR. METHODS:An international, retrospective study was performed in patients who underwent SSRF or nonoperative management for multiple rib fractures following CPR between January 1, 2012, and July 31, 2020. Patients who underwent SSRF were matched to nonoperative controls by cardiac arrest location and cause, rib fracture pattern, and age. The primary outcome was ICU LOS. RESULTS:Thirty-nine operatively treated patient were matched to 66 nonoperatively managed controls with comparable CPR-related characteristics. Patients who underwent SSRF more often had displaced rib fractures (n = 28 [72%] vs. n = 31 [47%]; p = 0.015) and a higher median number of displaced ribs (2 [P 25 -P 75 , 0-3] vs. 0 [P 25 -P 75 , 0-3]; p = 0.014). Surgical stabilization of rib fractures was performed at a median of 5 days (P 25 -P 75 , 3-8 days) after CPR. In the nonoperative group, a rib fixation specialist was consulted in 14 patients (21%). The ICU LOS was longer in the SSRF group (13 days [P 25 -P 75 , 9-23 days] vs. 9 days [P 25 -P 75 , 5-15 days]; p = 0.004). Mechanical ventilator-free days, hospital LOS, thoracic complications, and mortality were similar. CONCLUSION:Despite matching, those who underwent SSRF over nonoperative management for multiple rib fractures following CPR had more severe consequential chest wall injury and a longer ICU LOS. A benefit of SSRF on in-hospital outcomes could not be demonstrated.A low consultation rate for rib fixation in the nonoperative group indicates that the consideration to perform SSRF in this population might be associated with other nonradiographic or injury-related variables.

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Kardiyopulmoner Resüsitasyon Sonrası Dolaşımın Sağlandığı Hastalarda Gelişen Toraks Yaralanmaların Toraks BT ile Değerlendirilmesi

Ersoy¹,

Dadali²,

Çelik

et al. 2020

Kırıkkale Üniversitesi Tıp Fakültesi Dergisi

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In this study, we aimed to identify post-CPR (cardiopulmonary resuscitation) injuries. Material and Methods: This study was conducted retrospectively in 47 patients who had non-traumatic arrest and return of spontaneous circulation after CPR. Age, gender, CPR duration, findings of thoracic CT after CPR and mortality data of patients were evaluated. Results: The median age of the patients in our study was 73 years (IQR: 18) and 59.6% of the patients were female. The age and duration of CPR were significantly higher in patients with identified CPR-related injuries (p<0.05). There was no correlation between CPR-related injury and gender and death (p>0.05). Rib fractures were found in 48.9%, lung contusion in 23.4%, hemothorax in 17%, pneumothorax in 10.6%, pneumomediastinum in 4.3% and clavicle fracture in 2.1% of all patients. Conclusion: Injuries due to chest trauma often develop in cases that respond to CPR. Therefore, clinicians who follow-up the patient should keep in mind that injuries may occur after CPR and determine treatment protocols aimed for these complications in terms of post cardiac arrest. Amaç: Bu çalışmada kardiopulmoner resusitasyon (CPR) sonrası gelişen yaralanmaları tespit etmeyi amaçladık.

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Comparison of complications secondary to cardiopulmonary resuscitation between out-of-hospital cardiac arrest and in-hospital cardiac arrest

Cited by 3 publications

References 2 publications

Diaphragmatic rupture and massive pneumoperitoneum after cardiopulmonary resuscitation

Diaphragmatic rupture and massive pneumoperitoneum after cardiopulmonary resuscitation

Surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures following cardiopulmonary resuscitation: an international, retrospective matched case-control study (CWIS-CPR)

Kardiyopulmoner Resüsitasyon Sonrası Dolaşımın Sağlandığı Hastalarda Gelişen Toraks Yaralanmaların Toraks BT ile Değerlendirilmesi

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