Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

Abstract

Purpose Mechanical chest compression has been shown to be equivalent to manual chest compression in providing survival benefits to patients experiencing cardiac arrest. There has been a growing need for a contemporary review of iatrogenic injuries caused by mechanical in comparison with manual chest compression. Our study aims to analyze the studies that document significant life-threatening iatrogenic injuries caused by mechanical and manual chest compression. Methods A systematic review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. All studies published after January 1st, 2000 were reviewed using inclusion/exclusion criteria and completed by May 2020. A total of 7202 patients enrolled in 15 studies were included in our meta-analysis. Results Significant life-threatening iatrogenic injuries had higher odds of occurring when mechanical chest compression was used compared to manual chest compression, especially for hemothorax and liver lacerations. Mechanical chest compression involves consistently deeper compression depths compared to manual chest compression, potentially resulting in more injuries. In the mechanical chest compression cohort, chest wall fractures had the highest incidence rate (55.7%), followed by sternal fracture (28.3%), lung injuries (3.7%), liver (1.0%), and diaphragm (.2%) lacerations. Conclusions Mechanical chest compression was associated with more iatrogenic injuries as compared to manual chest compression. Further research is needed to define the appropriate application of mechanical in comparison with manual chest compression in different scenarios. Levels of provider training, different mechanical chest compression device types, patient demographics, and compression duration/depth may all play roles in influencing outcomes.

Left rib fractures during cardiopulmonary resuscitation are associated with hemodynamic variations in a pig model of cardiac arrest

“…Mechanical chest compression devices have been associated with elevated injury rates, including rib fractures, but also with improved 30-day survival for in-hospital cardiac arrest. 9 , 11 , 25 , 26 , 27 On the other hand, no study has shown a clear benefit of mechanical CPR for out-of-hospital cardiac arrest (OHCA). 28 , 29 …”

Isolated injury of the caudate lobe of the liver due to cardiopulmonary resuscitation

“…Mechanical chest compression has been reported to be associated with a higher risk of injuries than manual chest compression, particularly life‐threatening visceral injuries, with a study showing a prevalence of 10.7% potentially life‐threatening injuries in cases receiving mechanical chest compression, compared with none in the manual chest compression cases [1]. Iatrogenic injuries from chest compression most commonly involve rib fractures, sternal fractures, and lung injuries [2]. Liver injuries are infrequent, ranging from an incidence rate of 0.3% [1] to 3% [3] in various studies.…”