Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered

Abstract

It is generally considered that at least 1/3 of resuscitated patients sustain rib fractures and at least 1/5 sustains sternum fractures. However, our study showed that these injuries are much more frequent and that increased compression rate and depth cause more SCI. Since in the period 2011-2013 accompanying severe injuries occurred in only 1.85% of cases, the resuscitation technique has not yet jeopardised patient's safety, but further close monitoring is needed.

Risk factors for cardiopulmonary resuscitation‐related injuries sustained during out‐of‐hospital cardiac arrests

“…The past studies have reported variable incidences of CPR‐related injuries after OHCA. The incidence of rib fractures has ranged from 13% to 97% and sternal fractures from 1% to 79% . This wide variation is possibly due to the fact that these studies are from a 50‐year time span and the methods that have been used to analyse these injuries may have varied.…”

“…This wide variation is possibly due to the fact that these studies are from a 50‐year time span and the methods that have been used to analyse these injuries may have varied. The most recent autopsy studies report a high frequency of thoracic injuries, rib fractures as high as 85% and sternal fractures as high as 79% . A Japanese study examined both survivors and non‐survivors of OHCA using post‐mortem computed tomography and whole‐body computed tomography .…”

“…Injuries related to CPR attempts involve the chest, abdomen, retroperitoneum, face and neck; they also contribute to air and fat embolisms . The most common injuries involve the thoracic cage and thoracic viscera . The reported incidence of CPR‐related injuries varies widely among studies; a recent systematic review conducted a pooled analysis of reported post‐resuscitation injuries and found a 31% overall incidence for rib fractures and a 15% incidence for sternum fractures …”

“…The past studies have reported some risk factors for CPR‐related injuries, including older age, gender, longer duration of CPR, increased compression depth and rate, lower rate of return of spontaneous circulation (ROSC) and out‐of‐hospital cardiac arrests (OHCAs) . These studies have included both in‐hospital cardiac arrest (IHCA) patients and OHCA patients, with great variability regarding patient populations, EMS systems and hospital procedures.…”

Controlled automated reperfusion of the whole body after 120 minutes of Cardiopulmonary resuscitation: first clinical report

“…LUCAS™, Physio-Control; Lund, Sweden) have been developed to substitute high-tech performance for human efforts and support transportation. Although these devices provide a continuously improving quality of manual chest compressions, possible risks of injuring lung, heart, liver, spleen and chest wall have to be considered [18, 19]. Even though the patient was transported using a compression device, the severe metabolic acidosis with high lactate levels and low pH at the time of arrival were indicative of severe ischemia followed by a continued, generalized low-flow/low-pressure situation..…”