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CPR related injuries after manual or mechanical chest compressions with the LUCAS™ device: A multicentre study in victims after unsuccessful resuscitation
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.ORCID iD: 0000-0002-3563-6450
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, Forensic Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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2014 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 12, 1708-1712 p.Article in journal (Refereed) Published
Abstract [en]

AIM: The reported incidence of injuries due to cardiopulmonary resuscitation using manual chest compressions (manual CPR) varies greatly. Our aim was to elucidate the incidence of CPR-related injuries by manual chest compressions compared to mechanical chest compressions with the LUCAS device (mechanical CPR) in non-survivors after out-of-hospital cardiac arrest.METHODS: In this prospective multicentre trial, including 222 patients (83 manual CPR/139 mechanical CPR), autopsies were conducted after unsuccessful CPR and the results were evaluated according to a specified protocol.RESULTS: Among the patients included, 75.9% in the manual CPR group and 91.4% in the mechanical CPR group (p=0.002) displayed CPR-related injuries. Sternal fractures were present in 54.2% of the patients in the manual CPR group and in 58.3% in the mechanical CPR group (p=0.56). Of the patients in the manual CPR group, there were 64.6% with at least one rib fracture versus 78.8% in the mechanical CPR group (p=0.02). The median number of rib fractures among patients with rib fractures was 7 in the manual CPR group and 6 in the mechanical CPR group. No CPR-related injury was considered to be the cause of death.CONCLUSION: In patients with unsuccessful CPR after out-of-hospital cardiac arrest, rib fractures were more frequent after mechanical CPR but there was no difference in the incidence of sternal fractures. No injury was deemed fatal by the pathologist.

Place, publisher, year, edition, pages
2014. Vol. 85, no 12, 1708-1712 p.
Keyword [en]
Sudden cardiac arrest, Cardiopulmonary resuscitation, Injury, Complications, Autopsy, Device, LUCAS
National Category
Other Clinical Medicine
Research subject
Medicine
Identifiers
URN: urn:nbn:se:uu:diva-204638DOI: 10.1016/j.resuscitation.2014.09.017ISI: 000346603700019PubMedID: 25277343OAI: oai:DiVA.org:uu-204638DiVA: diva2:639361
Available from: 2013-08-07 Created: 2013-08-07 Last updated: 2017-12-06Bibliographically 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, DavidLindgren, ErikSandler, HåkanJohansson, JakobRubertsson, Sten

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