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No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS device--a pilot study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
2009 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, no 10, 1104-1107 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To compare the variety and incidence of internal injuries after manual and mechanical chest compressions during CPR. METHODS: In a prospective pilot study conducted in two Swedish cities, 85 patients underwent autopsy after unsuccessful resuscitation attempts with manual or mechanical chest compressions, the latter with the LUCAS device. Autopsy was performed and the results were evaluated according to a specified protocol. RESULTS: No injuries were found in 26/47 patients in the manual group and in 16/38 patients in the LUCAS group (p=0.28). Sternal fracture was present in 10/47 in the manual group and 11/38 in the LUCAS group (p=0.46), and there were multiple rib fractures (> or =3 fractures) in 13/47 in the manual group and in 17/38 in the LUCAS group (p=0.12). Bleeding in the ventral mediastinum was noted in 2/47 and 3/38 in the manual and LUCAS groups respectively (p=0.65), retrosternal bleeding in 1/47 and 3/38 (p=0.32), epicardial bleeding in 1/47 and 4/38 (p=0.17), and haemopericardium in 4/47 and 3/38 (p=1.0) respectively. One patient in the LUCAS group had a small rift in the liver and one patient in the manual group had a rift in the spleen. These injuries were not considered to have contributed to the patient's death. CONCLUSION: Mechanical chest compressions with the LUCAS device appear to be associated with the same variety and incidence of injuries as manual chest compressions.

Place, publisher, year, edition, pages
2009. Vol. 80, no 10, 1104-1107 p.
Keyword [en]
Cardiac arrest, Injury, Active compression-decompression (ACD), Cardiopulmonary resuscitation (CPR), LUCAS, Autopsy
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-113248DOI: 10.1016/j.resuscitation.2009.06.010ISI: 000271336400005PubMedID: 19595496OAI: oai:DiVA.org:uu-113248DiVA: diva2:290258
Available from: 2010-01-26 Created: 2010-01-26 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Safety with Mechanical Chest Compressions in CPR: Clinical studies with the LUCAS™ device
Open this publication in new window or tab >>Safety with Mechanical Chest Compressions in CPR: Clinical studies with the LUCAS™ device
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chest compressions in cardiopulmonary resuscitation are of utmost importance although not without a risk. Many injuries are described but the incidence of these is hard to define due to methodological differences. It is strenuous to perform chest compressions and therefore mechanical chest compressions have been looked upon with interest. This thesis presents new insights on the panorama and incidence of injuries in modern CPR and a comparison of safety and efficacy between manual chest compressions and mechanical chest compressions with the LUCAS™ device.

We also evaluated if computed tomography could be an aid in the detection of these injuries.

Two pilot trials were conducted and one presented no difference in early survival with 26% and 31% having return of spontaneous circulation when comparing manual chest compressions with the LUCAS device in out-of-hospital cardiac arrest. The other revealed no difference in autopsy-detected injuries. A third multicentre autopsy trial revealed that in patients treated with manual chest compressions 78.3% had at least one injury and 63.9% had at least one rib fracture. The corresponding numbers for patients treated with the LUCAS device was 92.8% (p = 0.002) and 77.7% (p=0.022). Sternal fractures occurred in 54.2% and in 58.3% of the cases treated with manual chest compressions and the LUCAS device respectively (p = 0.556). The median number of rib fractures was 7 in the group receiving manual chest compressions and 6 in the group receiving chest compressions with the LUCAS device. In 31 cases a computed tomography was conducted prior to autopsy and we found a very strong correlation in the discrimination of patients with or without rib fractures (kappa=0.83). Mean difference between the two methods in detecting rib fractures was 0.16. The detection of other injuries did not have a strong correlation. In conclusion there is no difference in early survival between the two methods and mechanical chest compressions adds 14-15% more patients with rib fractures but the amount of rib fractures, sternal fractures and other injuries is equal. CT can aid but not replace autopsies in the detection of these injuries.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 69 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 922
Keyword
Cardiac arrest, Cardiopulmonary resuscitation, Mechanical chest compressions, Active compression-decompression, Injury, Autopsy, LUCAS
National Category
Other Clinical Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:uu:diva-204069 (URN)978-91-554-8716-4 (ISBN)
Public defence
2013-09-27, Ebba Enghoffsalen, Ingång 50 bv., Akademiska Sjukhuset, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2013-09-03 Created: 2013-07-21 Last updated: 2014-01-07

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Smekal, DavidJohansson, JakobRubertsson, Sten

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