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

Youcef Azeli; Eneko Barbería; Alberto Fernández; Silvia García-Vilana; Alfredo Bardají; Bjarne Madsen Hardig

doi:10.1016/j.resplu.2022.100242

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

Resusc Plus. 2022 May 11:10:100242. doi: 10.1016/j.resplu.2022.100242. eCollection 2022 Jun.

Authors

Youcef Azeli^{1

2

3}, Eneko Barbería^{4

5}, Alberto Fernández⁶, Silvia García-Vilana⁷, Alfredo Bardají^{5

8}, Bjarne Madsen Hardig⁹

Affiliations

¹ Sistema d'Emergències Mèdiques de Catalunya, Spain.
² Emergency Department, Sant Joan University Hospital, Reus, Spain.
³ Institut d'Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain.
⁴ Pathology Service, Institute of Legal Medicine and Forensic Sciences of Catalonia, Tarragona, Spain.
⁵ Rovira i Virgili University, Tarragona, Spain.
⁶ Universitat Rovira i Virgili, Departament d'Enginyeria Química, Tarragona, Spain.
⁷ Escola d'Enginyeria de Barcelona Est, Universitat Politècnica de Catalunya, Spain.
⁸ Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain.
⁹ Department of Clinical Sciences, Medical Faculty, Lund University, Helsingborg, Sweden.

Abstract

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.

Keywords: Cardiopulmonary resuscitation; Out-of-hospital cardiac arrest; Sudden death; Thoracic injuries.