Trauma associated with cardiopulmonary resuscitation based on autopsy reports after the 2015 ERC guidelines.

INTRODUCTION: Cardiopulmonary resuscitation (CPR)-related injuries have not been assessed since the 2015 Resuscitation Guidelines were established. AIM: To describe the incidence and severity of CPR-related injuries, and to evaluate the impact of the 2015 European Resuscitation Council (ERC) guidelines on the objective assessment of injuries. METHODS: This multicenter, retrospective study analyzed autopsy reports of patients who underwent CPR. The most severe injuries were objectively assessed using the Abbreviated Injury Scale (AIS) and all injuries were summarized according to the New Injury Severity Score (NISS). RESULTS: Among 628 autopsy reports analyzed, patient characteristics and case details were distributed as follows: male sex, 71.1%; median age, 67 years; out-of-hospital cardiac arrest, 89.2%; bystander CPR, 56.8%. CPR-related injuries included: rib(s) 94.6%; lung(s), 9.9%; sternum, 62.4%; liver, 2.5%; and spleen, 1.8%. The incidence of bystander-provided CPR and severity of injury were similar to CPR provided only by professionals. There were no difference between mechanical and manual compressions. Females were older (p = 0.0001) and, although the frequency of their injuries was similar to males, they were significantly more severe (p = 0.01). Patients with life-threatening injury exhibited a baseline profile similar to those without injury . The median score (according to AIS) of the most severe injury was 3 and the median of summary of injuries was 13 according to the NISS-low risk of fatal injury. CONCLUSION: CPR-related injuries occurred frequently, although those that were life-threatening accounted for only 3% of cases. There were no differences between patients who were resuscitated by bystander(s) or by professionals and no differences between mechanical chest devices or manual resuscitation. Compared with a study based on the 2010 guidelines, similar injuries were found, but with more rib fractures, less visceral organ damage, and fewer life-threatening injuries.

The comparison of cardiopulmonary resuscitation-related trauma: Mechanical versus manual chest compressions.

INTRODUCTION: AIM:: To compare injuries after cardiopulmonary resuscitation (CPR) caused by manual or mechanical chest compressions in resuscitated patients with non-traumatic cardiac arrest. METHODS: This retrospective, multicenter study was based on autopsy reports of patients who died after CPR; individuals with a traumatic cause(s) of cardiac arrest were excluded. Patients were divided into two CPR groups: mechanical and manual. The Abbreviated Injury Scale was used to objectively evaluate the most serious injuries and the New Injury Scale Score was used to summarize all injuries. RESULTS: Of 704 patients, data from 630 individuals were analyzed after exclusion of those with trauma-related cardiac arrest. Manual CPR was performed in 559 patients and mechanical in 64 subjects. There were no differences in sex, bystander CPR, or etiology of cardiac arrest between the two groups, however, mechanical CPR was significantly longer (X vs. Y, p = 0.0005) and patients in this group were younger (X vs. Y, p = 0.0067). No differences were found in the incidence of CPR-related injuries between the groups. The median number of the most serious injury (according to Abbreviated Injury Scale) was 3, which was not statistically different; the median number of injuries according to the New Injury Severity Score was 13 in both groups (low probability of fatal injury). Type of injuries were also similar with the exception of pericardial damage that was more prevalent in mechanical CPR group. Only age and bystander CPR were found to be independently associated with the autopsy-documented trauma. CONCLUSION: Our results suggest that mechanical chest compressions do not increase the incidence and severity of CPR-related injury in comparison with manual methods despite significantly longer CPR duration.