Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study

Jin Ho Beom; Je Sung You; Min Joung Kim; Min Kyung Seung; Yoo Seok Park; Hyun Soo Chung; Sung Phil Chung; Incheol Park

doi:10.1186/s13049-017-0352-6

Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study

Scand J Trauma Resusc Emerg Med. 2017 Jan 26;25(1):8. doi: 10.1186/s13049-017-0352-6.

Authors

Jin Ho Beom¹, Je Sung You¹, Min Joung Kim¹, Min Kyung Seung², Yoo Seok Park³, Hyun Soo Chung¹, Sung Phil Chung¹, Incheol Park¹

Affiliations

¹ Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
² Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Gyeonggi-Do, Republic of Korea.
³ Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea. pys0905@yuhs.ac.

Abstract

Background: The purpose of this study was to identify the relationship between the deeper and faster chest compressions suggested by the 2010 cardiopulmonary resuscitation guidelines and complications arising from chest compressions, using multi-detector computed tomography.

Methods: We performed a retrospective analysis of prospective registry data. This study was conducted with in- and out-of-hospital cardiac arrest patients who underwent successful resuscitation in the emergency departments of two academic tertiary care centres from October 2006 to September 2010 (pre-2010 group) and from October 2011 to September 2015 (post-2010 group). We examined chest injuries related to chest compressions, classified as follows: rib fracture, sternal fracture, and other uncommon complications.

Results: We enrolled 185 patients in this study. The most frequent complication to occur in both groups was rib fracture: 27 (62.8%) and 112 (78.9%) patients in the pre-2010 and post-2010 groups, respectively (p = 0.03). However, we observed no statistical differences in sternum fracture, the second most common complication (p = 0.80). Retrosternal and mediastinal haematoma were not reported in the pre-2010 group but 13 patients (9.1%) in the post-2010 group were reported to have haematoma (p = 0.04). Nine serious, life-threatening complications occurred, all in the post-2010 group. Among the younger group (less than 65 years old), 8 (38.1%) patients in the pre-2010 group and 40 (64.5%) in the post-2010 group sustained rib fractures.

Discussion: The deeper and faster chest compressions for enhancing ROSC are associated with increased occurrence of complications. Additional studies are needed to compensate for the limitations of our study design.

Conclusions: This study found that the 2010 guidelines, recommending deeper and faster chest compressions, led to an increased proportion of rib fractures and retrosternal and mediastinal haematoma.

Keywords: Cardiopulmonary resuscitation guideline; Chest compression; Complication; Multi-detector computed tomography.

MeSH terms

Cardiopulmonary Resuscitation / methods*
Emergency Service, Hospital
Heart Arrest / therapy*
Heart Massage / adverse effects*
Humans
Multidetector Computed Tomography*
Out-of-Hospital Cardiac Arrest / therapy
Practice Guidelines as Topic*
Registries
Retrospective Studies
Thoracic Injuries / diagnostic imaging*
Thoracic Injuries / etiology*