Study of risk factors for injuries due to cardiopulmonary resuscitation with special focus on the role of the heart: A machine learning analysis of a prospective registry with multiple sources of information (ReCaPTa Study).

Background: The study of thoracic injuries and biomechanics during CPR requires detailed studies that are very scarce. The role of the heart in CPR biomechanics has not been determined. This study aimed to determine the risk factors importance for serious ribcage damage due to CPR. Methods: Data were collected from a prospective registry of out-of-hospital cardiac arrest between April 2014 and April 2017. This study included consecutive out-of-hospital CPR attempts undergoing an autopsy study focused on CPR injuries. Cardiac mass ratio was defined as the ratio of real to expected heart mass. Pearson's correlation coefficient was used to select clinically relevant variables and subsequently classification tree models were built. The Gini index was used to determine the importance of the associated serious ribcage damage factors. The LUCAS® chest compressions device forces and the cardiac mass were analyzed by linear regression. Results: Two hundred CPR attempts were included (133 manual CPR and 67 mechanical CPR). The mean age of the sample was 60.4 ± 13.5, and 56 (28%) were women. In all, 65.0% of the patients presented serious ribcage damage. From the classification tree build with the clinically relevant variables, age (0.44), cardiac mass ratio (0.26), CPR time (0.22), and mechanical CPR (0.07), in that order, were the most influential factors on serious ribcage damage. The chest compression forces were greater in subjects with higher cardiac mass. Conclusions: The heart plays a key role in CPR biomechanics being cardiac mass ratio the second most important risk factor for CPR injuries.

Revealing the role of material properties in impact-related injuries: Investigating the influence of brain and skull density variations on head injury severity.

Traumatic brain injuries (TBI) resulting from head impacts are a major public health concern, which prompted our research to investigate the complex relationship between the material properties of brain tissue and the severity of TBI. The goal of this research is to investigate how variations in brain and skull density influence the vulnerability of brain tissue to traumatic injury, thereby enhancing our understanding of injury mechanism. To achieve this goal, we employed a well-validated finite element head model (FEHM). The current investigation was divided into two phases: in the first one, three distinct brain viscoelastic materials that had been utilized in prior studies were analyzed. The review of the properties of these three materials has been meticulous, encompassing both the spectrum of mechanical properties and the behaviors that are relevant to the way in which brain tissue reacts to traumatic loading conditions. In the second phase, the material properties of both the brain and skull tissue, alongside the impact conditions, were held constant. After this step, the focus was directed towards the variation of density in the brain and skull, which was consistent with the results obtained from previous experimental investigations, in order to determine the precise impact of these variations in density. This approach allowed a more profound comprehension of the impacts that density had on the simulation results. In the first phase, Material No. 2 exhibited the highest maximum first principal strain value in the frontal region (εmax=15.41%), indicating lower stiffness to instantaneous deformation. This characteristic suggests that Material No. 2 may deform more extensively upon impact, potentially increasing the risk of injury due to its viscoelastic behavior. In contrast, Material No. 1, with a lower maximum first principal strain in the frontal region (εmax=7.87%), displayed greater stiffness to instantaneous deformation, potentially reducing the risk of brain injury upon head impact. The second phase provided quantitative findings revealing a proportional relationship between brain tissue density and the pressures experienced by the brain. A 2 % increase in brain tissue density corresponded to approximately a 1 % increase in pressure on the brain tissue. Similarly, changes in skull density exhibited a similar quantitative relationship, with a 6 % increase in skull density leading to a 2.5 % increase in brain pressure. This preliminary approximate ratio of 2 to 1 between brain and skull density variations provides an initial quantitative framework for assessing the impact of density changes on brain vulnerability. These findings have several implications for the development of protective measures and injury prevention strategies, particularly in contexts where head trauma is a major issue.

Quantifying the effect of cerebral atrophy on head injury risk in elderly individuals: Insights from computational biomechanics and experimental analysis of bridging veins.

The objective of this study was to quantitatively investigate the relationship between cerebral atrophy and the risk of injury in elderly individuals. To achieve this, a sophisticated computational biomechanics approach utilizing finite element analysis was employed to simulate the mechanical behavior of the brain and skull under various conditions. In addition, particular emphasis was placed on understanding the role of cerebral bridging veins (BVs) and their mechanical properties at different ages in the occurrence of head injuries. Head models representing healthy brains and five atrophy models were developed based on imaging data. After validation, the models underwent the identical impact loading conditions to enable the simulation of brain damage. The resulting outcomes of the models with brain atrophy were then compared to the results obtained from the healthy model, allowing for a comparative analysis. Simulations showed increased relative displacement with worsening brain atrophy, particularly in the frontal and occipital regions. Compared to the healthy brain model, relative displacement increased by 2.36 %-9.21 % in the atrophy models, indicating an elevated risk of injury. In severe brain atrophy (FEM 6), the strain reached 83.59 % in local model simulations, leading to damage and rupture of cerebral BVs in both young and elderly individuals. Mechanical tests on cerebral BVs demonstrated a negative correlation between age and ultimate force, stress, and strain, suggesting increased susceptibility to damage with age. An observed sharp decline of approximately 50 % in ultimate stress and 35 % in ultimate strain was noted as age increased. We implemented a 50 % reduction in the intensity of head impact forces; nevertheless, vascular damage continues to manifest in the elderly population. To establish a truly safe zone, it is imperative to further decrease the intensity of the impact. This investigation represents a significant step forward in our understanding of the complex interplay between cerebral atrophy, the mechanical properties of BVs at different age, and the risk of head injury in the elderly. Through continued research in this field, we can strive to improve the quality of care, enhance prevention strategies, and ultimately enhance the well-being and safety of the elderly population.

Viscoelastic Characterization of a Thermoplastic Elastomer Processed through Material Extrusion.

Objective. We aim to characterize the viscoelastic behavior of Polyether-Block-Amide (PEBA 90A), provide reference values for the parameters of a constitutive model for the simulation of mechanical behaviors, and paying attention to the influence of the manufacturing conditions. Methods. Uniaxial relaxation tests of filaments of PEBA were used to determine the values of the parameters of a Prony series for a Quasi-Linear Visco-Elastic (QLVE) model. Additional, fast cyclic loading tests were used to corroborate the adequacy of the model under different test criteria in a second test situation. Results. The QLVE model predicts the results of the relaxation tests very accurately. In addition, the behavior inferred from this model fits very well with the measurements of fast cyclic loading tests. The viscoelastic behavior of PEBA under small strain polymer fits very well to a six-parameter QLVE model.

Chest wall mechanics during mechanical chest compression and its relationship to CPR-related injuries and survival.

Aim: To determine compression force variation (CFV) during mechanical cardiopulmonary resuscitation (CPR) and its relationship with CPR-related injuries and survival. Methods: Adult non-traumatic OHCA patients who had been treated with mechanical CPR were evaluated for CPR-related injuries using chest X-rays, thoracic computed tomography or autopsy. The CFV exerted by the LUCAS 2 device was calculated as the difference between the maximum and the minimum force values and was categorised into three different groups (high positive CFV ≥ 95 newton (N), high negative CFV ≤ -95 N, and low variation for intermediate CFV). The CFV was correlated with the CPR injuries findings and survival data. Results: Fifty-two patients were included. The median (IQR) age was 57 (49-66) years, and 13 (25%) cases survived until hospital admission. High positive CFV was found in 21 (40.4%) patients, high negative CFV in 9 (17.3%) and a low CFV in 22 (42.3%). The median (IQR) number of rib fractures was higher in the high positive and negative CFV groups compared with the low CFV group [7(1-9) and 9 (4-11) vs 0 (0-6) (p = 0.021)]. More bilateral fracture cases were found in the high positive and negative CFV groups [16 (76.2%) and 6 (66.7%) vs 6 (27.3%) (p = 0.004)]. In the younger half of the sample more patients survived until hospital admission in the low CFV group compared with the high CFV groups [5 (41.7%) vs 1 (7.1%) (p = 0.037)]. Conclusions: High CFV was associated with ribcage injuries. In the younger patients low CFV was associated with survival until hospital admission.

Injury Metrics for Assessing the Risk of Acute Subdural Hematoma in Traumatic Events.

Worldwide, the ocurrence of acute subdural hematomas (ASDHs) in road traffic crashes is a major public health problem. ASDHs are usually produced by loss of structural integrity of one of the cerebral bridging veins (CBVs) linking the parasagittal sinus to the brain. Therefore, to assess the risk of ASDH it is important to know the mechanical conditions to which the CBVs are subjected during a potentially traumatic event (such as a traffic accident or a fall from height). Recently, new studies on CBVs have been published allowing much more accurate prediction of the likelihood of mechanical failure of CBVs. These new data can be used to propose new damage metrics, which make more accurate predictions about the probability of occurrence of ASDH in road crashes. This would allow a better assessement of the effects of passive safety countermeasures and, consequently, to improve vehicle restraint systems. Currently, some widely used damage metrics are based on partially obsolete data and measurements of the mechanical behavior of CBVs that have not been confirmed by subsequent studies. This paper proposes a revision of some existing metrics and constructs a new metric based on more accurate recent data on the mechanical failure of human CBVs.

Viscoelastic Characterization of Parasagittal Bridging Veins and Implications for Traumatic Brain Injury: A Pilot Study.

Many previous studies on the mechanical properties of Parasagittal Bridging Veins (PSBVs) found that strain rate had a significant effect on some mechanical properties, but did not extensively study the viscoelastic effects, which are difficult to detect with uniaxial simple tensile tests. In this study, relaxation tests and tests under cyclic loading were performed, and it was found that PSBVs do indeed exhibit clear viscoelastic effects. In addition, a complete viscoelastic model for the PSBVs is proposed and data from relaxation, cyclic load and load-unload tests for triangular loads are used to find reference values that characterize the viscoelastic behavior of the PSBVs. Although such models have been proposed for other types of blood vessels, this is the first study that clearly demonstrates the existence of viscoelastic effects from an experimental point of view and also proposes a specific model to explain the data obtained. Finally, this study provides reference values for the usual viscoelastic properties, which would allow more accurate numerical simulation of PSBVs by means of computational models.

Mechanical Behavior of Blood Vessels: Elastic and Viscoelastic Contributions.

The mechanical properties of the cerebral bridging veins (CBVs) were studied using advanced microtensile equipment. Detailed high-quality curves were obtained at different strain rates, showing a clearly nonlinear stress-strain response. In addition, the tissue of the CBVs exhibits stress relaxation and a preconditioning effect under cyclic loading, unequivocal indications of viscoelastic behavior. Interestingly, most previous literature that conducts uniaxial tensile tests had not found significant viscoelastic effects in CBVs, but the use of more sensitive tests allowed to observe the viscoelastic effects. For that reason, a careful mathematical analysis is presented, clarifying why in uniaxial tests with moderate strain rates, it is difficult to observe any viscoelastic effect. The analysis provides a theoretical explanation as to why many recent studies that investigated mechanical properties did not find a significant viscoelastic effect, even though in other circumstances, the CBV tissue would clearly exhibit viscoelastic behavior. Finally, this study provides reference values for the usual mechanical properties, as well as calculations of constitutive parameters for nonlinear elastic and viscoelastic models that would allow more accurate numerical simulation of CBVs in Finite Element-based computational models in future works.

A predictive model for fracture in human ribs based on in vitro acoustic emission data.

PURPOSE: The aim of this paper is to propose a fracture model for human ribs based on acoustic emission (AE) data. The accumulation of microcracking until a macroscopic crack is produced can be monitored by AE. The macrocrack propagation causes the loss of the structural integrity of the rib. METHODS: The AE technique was used in in vitro bending tests of human ribs. The AE data obtained were used to construct a quantitative model that allows an estimation of the failure stress from the signals detected. The model predicts the ultimate stress with an error of less than 3.5% (even at stresses 15% lower than failure stress), which makes it possible to safely anticipate the failure of the rib. RESULTS: The percolation theory was used to model crack propagation. Moreover, a quantitative probability-based model for the expected number of AE signals has been constructed, incorporating some ideas of percolation theory. The model predicts that AE signals associated with micro-failures should exhibit a vertical asymptote when stress increases. The occurrence of this vertical asymptote was attested in our experimental observations. The total number of microfailures detected prior to the failure is N ≈ 100 and the ultimate stress is σ ∞ = 197 ± 62 MPa. A significant correlation (p < 0.0001) between σ ∞ and the predicted value is found, using only the first N = 30 micro-failures (correlation improves for N higher). CONCLUSIONS: The measurements and the shape of the curves predicted by the model fit well. In addition, the model parameters seem to explain quantitatively and qualitatively the distribution of the AE signals as the material approaches the macroscopic fracture. Moreover, some of these parameters correlate with anthropometric variables, such as age or Body Mass Index. The proposed model could be used to predict the structural failure of ribs subjected to bending.

Influence of anthopometric variables on the mechanical properties of human rib cortical bone.

Objective. The mechanical properties of ribs from a large number ofpost-mortemhuman subjects (PMHS) were analyzed to search for variation according to age, sex or BMI in the sample. A large sample of specimens from different donors (N= 64) with a very wide range of ages and anthropometric characteristics was tested.Methods. Uniaxial tensile tests were used for a sample of coupons machined from cortical bone tissue in order to isolate the purely mechanical properties from the geometrically influenced properties of the rib. Each coupon is about 25 mm long and has a thickness of about 0.5 mm. The mechanical properties measured for each specimen/coupon include YM, yield stress, ultimate stress (maximum failure stress), ultimate strain, and resilience (energy to fracture of SED). The study provides new methodological improvements in DIC techniques.Results. This study is notable for using an atypically large sample of number of PMHS. The size of the sample allowed the authors to determine that age has a significant effect on failure stress (p< 0.0001), yield stress (p= 0.0047), ultimate strain (p< 0.0001) and resilience (p< 0.0001) [numbers in parentheses represent the correspondingp- values]. Finally, there is a combined effect, so that for a given age, an increase of BMI leads to a decrease of the maximum strain (i.e. cortical bone is less stiff when both age and BMI are higher).

Prediction of mechanical properties of human rib cortical bone using fractal dimension.

A large number of post mortem human subjects was used to investigate the relation between the micro-structure of rib cortical bone and the mechanical properties using Fractal Dimension. Uniaxial tensile tests were performed on coupons of rib cortical bone. Tensile strength, yield stress, Young's Modulus, maximum strain, and work to fracture were determined for each coupon. Fractal dimension was computed using CT images and Digital Image Correlation procedures. A highly significant effect of fractal dimension in the mechanical properties was found. In addition, the variation in mechanical properties was found to be adequately represented by Generalized Extreme Value type distributions.