Abstract 103: Rib and Sternum Fractures After Cardiopulmonary Resuscitation: An Autopsy Study
Introduction: Chest compression during cardiopulmonary resuscitation (CPR) is associated with skeletal chest injury. The aim of this study was to investigate the incidence of rib and sternum fractures after mechanical active compression-decompression CPR (aCPR) and standard manual CPR (mCPR).
Method: This prospective study was conducted from January 1 2005 through December 31 2013. We included adult patients (age ≥18 years) who did not survive after CPR and were referred for clinical autopsy. The patients had been treated with either the aCPR device Lund University Cardiac Arrest System (LUCAS) or mCPR only. Patient and CPR data was drawn from autopsy referral documents or the patient medical records. Out of many referred cases, inclusion required examination by one of two pathologists with experience of CPR-related injuries. Autopsy was performed with special attention given to skeletal chest injuries and a standardized written protocol was used.
Results: In the period 2005-2013 we included 362 cases treated with aCPR and 52 cases treated with mCPR. Sternum fracture was found in 291/362 cases (80 %) in the aCPR group and in 20/52 cases (38 %; p<0.001) in the mCPR group. Rib fracture was found in 349/362 cases (96 %) in the aCPR group and in 40/52 cases (77 %; p<0.001) in the mCPR group. Fracture on ≥ three ribs was present in 334/362 cases (92 %) in the aCPR group and in 36/52 cases (69 %; p<0.001) in the mCPR group. In the majority of cases there were multiple bilateral rib fractures, with a median of 10 fractures per case (interquartile range 7 to 13 fractures) in the aCPR group and 7 fractures per case (interquartile range 1 to 9.75 fractures; p<0.001) in the mCPR group. There was no fracture in 6/362 cases (1.7 %) in the aCPR group and in 10/52 cases (19 %; p<0.001) in the mCPR group.
Conclusion: The incidence of rib and sternum fracture was significantly higher after aCPR than after mCPR, sternum fractures being twice as common and rib fractures being markedly more numerous after aCPR. These findings should be considered in the light of emerging survival data.
Author Disclosures: N. Friberg: None. C. Walther: None. E. Englund: None.
- © 2014 by American Heart Association, Inc.