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Comparison of computed tomography and autopsy in detection of injuries after unsuccessful cardiopulmonary resuscitation
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 Radiology, Oncology and Radiation Science, Radiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
2013 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 84, no 3, 357-360 p.Article in journal (Refereed) Published
Abstract [en]

AIM:

Computed tomography (CT) has been suggested as an aid or even a replacement for autopsy. The aim of this trial was to study the conformity of the two methods in finding injuries in non-surviving patients after unsuccessful cardiopulmonary resuscitation.

METHODS:

In this prospective study, 31 patients were submitted to a CT prior to autopsy after unsuccessful resuscitation attempts. Pathological findings were noted by both the radiologist and the pathologists in a specified protocol. The pathologists and radiologist were blinded from each other's results.

RESULTS:

CT and autopsy revealed rib fractures in 22 and 24 patients respectively (kappa=0.83). In 8 patients, CT revealed more rib fractures than autopsy; and in 12 patients, autopsy revealed more rib fractures than CT. In 7 patients, neither method showed any rib fractures. The mean difference between the two methods in detecting rib fractures was 0.16 (S.D.: ±3.174, limits of agreement: -6.19 to 6.51). The kappa value for sternal fractures was 0.49. A total of 260 pathological findings were noted by CT and 244 by autopsy. The average patient showed a median of 9 injuries (every fracture counted as one injury), independent of the method used in detecting the injuries.

CONCLUSIONS:

There was a strong concordance between the two methods in finding rib fractures but not sternal fractures and these results support the concept of CT as a valuable complement to autopsy in detecting rib fractures after unsuccessful cardiopulmonary resuscitation but not as a replacement. Other injuries did not show the same concordance.

Place, publisher, year, edition, pages
2013. Vol. 84, no 3, 357-360 p.
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:uu:diva-182251DOI: 10.1016/j.resuscitation.2012.06.023ISI: 000318164200025PubMedID: 22776515OAI: oai:DiVA.org:uu-182251DiVA: diva2:559165
Available from: 2012-10-08 Created: 2012-10-08 Last updated: 2017-12-07Bibliographically 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, DavidHansen, TomasSandler, HåkanRubertsson, Sten

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