<scp>CPR</scp> related thoracic injury: a comparison of <scp>CPR</scp> guidelines between 2005 and 2010

Oya, Seiro; Shinjo, Takafumi; Fujii, Yasuhiro; Kamo, Jun; Teruya, Hideki; Kinoshita, Hirohisa

doi:10.1002/ams2.215

Cited by 9 publications

(5 citation statements)

References 20 publications

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“…Japanese men, on average, had an APD that was 50 mm smaller than Caucasian men and thus may have been more vulnerable to iatrogenic trauma during mechanical chest compression. 27 We suggest that similar studies be conducted in countries other than Japan to help generalize these findings and ultimately contribute to an improved design and protocol for mechanical chest compression devices that take chest AP diameter into account.…”

Section: Future Directionsmentioning

confidence: 79%

Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

Chun

Zhang

Toraih

et al. 2021

The American Surgeon™

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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.

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Section: Future Directionsmentioning

confidence: 79%

Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

Chun

Zhang

Toraih

et al. 2021

The American Surgeon™

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“…In 2010, guidelines increased the recommended depth of chest compression from 4-5 cm to 5-6 cm, while introducing a faster rate of 100-120 compressions per minute. Although these changes aimed at improving hemodynamic support and ultimately patient outcomes, they have also been associated with a higher incidence of thoracic injuries [25,26].…”

Section: Cpr-related Injuriesmentioning

confidence: 99%

Acute Lung Injury after Cardiopulmonary Resuscitation: A Narrative Review

Marchese,

Bungaro,

Magliocca

et al. 2024

JCM

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Although cardiopulmonary resuscitation (CPR) includes lifesaving maneuvers, it might be associated with a wide spectrum of iatrogenic injuries. Among these, acute lung injury (ALI) is frequent and yields significant challenges to post-cardiac arrest recovery. Understanding the relationship between CPR and ALI is determinant for refining resuscitation techniques and improving patient outcomes. This review aims to analyze the existing literature on ALI following CPR, emphasizing prevalence, clinical implications, and contributing factors. The review seeks to elucidate the pathogenesis of ALI in the context of CPR, assess the efficacy of CPR techniques and ventilation strategies, and explore their impact on post-cardiac arrest outcomes. CPR-related injuries, ranging from skeletal fractures to severe internal organ damage, underscore the complexity of managing post-cardiac arrest patients. Chest compression, particularly when prolonged and vigorous, i.e., mechanical compression, appears to be a crucial factor contributing to ALI, with the concept of cardiopulmonary resuscitation-associated lung edema (CRALE) gaining prominence. Ventilation strategies during CPR and post-cardiac arrest syndrome also play pivotal roles in ALI development. The recognition of CPR-related lung injuries, especially CRALE and ALI, highlights the need for research on optimizing CPR techniques and tailoring ventilation strategies during and after resuscitation.

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“…Chest compressions for cardiopulmonary resuscitation (CPR) were emphasized in the 2010 American Heart Association CPR guidelines [ 1 ]. However, CPR-related bleeding complications are not uncommon [ 2 – 4 ], and CPR-related fractures have been observed more frequently since 2010 [ 5 , 6 ]. Furthermore, CPR-related bleeding, particularly internal mammary artery (IMA) injuries, can become life-threatening in patients who undergo extracorporeal cardiopulmonary resuscitation (ECPR) because concomitant anticoagulant treatment [ 7 ], antiplatelet treatment, targeted temperature management [ 8 ], and bleeding coagulopathy [ 9 ] are often involved.…”

Section: Introductionmentioning

confidence: 99%

Chest compression-related fatal internal mammary artery injuries manifesting after venoarterial extracorporeal membrane oxygenation: a case series

et al. 2017

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BackgroundCardiopulmonary resuscitation-related bleeding, especially internal mammary artery injuries, can become life-threatening complications after initiating venoarterial extracorporeal membrane oxygenation owing to the frequent involvement of concomitant anticoagulant treatment, antiplatelet treatment, targeted temperature management, and bleeding coagulopathy. We report the cases of five patients who experienced this complication and discuss their management.Case presentationWe retrospectively evaluated five patients with cardiopulmonary resuscitation-related internal mammary artery injuries who were treated between February 2011 and February 2016 at our institution. All five patients were Asian men, aged 56 to 68-years old, who had received concomitant intravenously administered unfractionated heparin (3000 units) with antiplatelet therapy. Four patients received targeted temperature management. The injuries and hematomas were detected using contrast-enhanced computed tomography in all cases. Three patients were treated using transcatheter arterial embolization within 6 hours following cardiopulmonary arrest, and two were resuscitated and received appropriate treatment following early recognition of their injuries. Two patients died of hemorrhagic shock with delayed intervention. Four of the five patients had excessively prolonged activated partial thromboplastin times before their interventions.ConclusionsComputed tomography should be performed as soon as possible after the return of spontaneous circulation to identify injuries and consider appropriate treatments for patients who have experienced cardiac arrest. Delayed bleeding may develop after treating hypovolemic shock and relieving arterial spasms; therefore, transcatheter arterial embolization should be performed aggressively to prevent delayed bleeding even in the absence of extravasation. This approach may be superior to thoracotomy because it is less invasive, causes less bleeding, and can selectively stop arterial bleeding sooner. A 3000-unit intravenous bolus of unfractionated heparin may be redundant; heparin-free extracorporeal cardiopulmonary resuscitation may be a more appropriate alternative. Unfractionated heparin treatment can commence after the bleeding has stopped.

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CPR related thoracic injury: a comparison of CPR guidelines between 2005 and 2010

Cited by 9 publications

References 20 publications

Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

Iatrogenic Injuries in Manual and Mechanical Cardiopulmonary Resuscitation

Acute Lung Injury after Cardiopulmonary Resuscitation: A Narrative Review

Chest compression-related fatal internal mammary artery injuries manifesting after venoarterial extracorporeal membrane oxygenation: a case series

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