Authors: Smekal D et al., Resuscitation 2014 Sep 29;
Autopsies revealed chest-compression–related injuries, mostly rib fractures, in more than 75% of patients.
To compare injuries from manual versus mechanical chest compressions, researchers in Sweden conducted a prospective multicenter study of 222 adults who had autopsies after unsuccessful cardiopulmonary resuscitation (CPR) following nontraumatic cardiac arrest.
Overall, 76% of 83 patients who received manual compressions versus 91% of 139 who received mechanical compressions (with the LUCAS device) had CPR-related injuries. Rib fractures were more common after mechanical CPR (79% vs. 65%); most patients in both groups had multiple rib fractures. The incidence of sternal fractures was about 55% in each of the two groups. Older patients were more likely to have injuries than younger patients (mean age, 69 vs. 56 years). All of the 46 patients with osteoporosis had rib fractures and most had sternal fractures. Other injuries were infrequent. Pathologists declared that none of the injuries observed were the cause of death.
Although the injuries described in this study were in nonsurvivors, injuries are likely to be similar in patients who are successfully resuscitated. “Push hard and fast” saves lives, but also causes injuries. In patients who have received CPR, consider the high incidence of fractures and be sure to assess for complications, such as pneumothorax, and to adequately treat pain to provide comfort and to prevent precipitation of cardiac ischemia.
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