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

J Karasek; A Blankova; A Doubková; T Pitasova; D Nahalka; T Bartes; J Hladik; T Adamek; T Jirasek; R Polasek; P Ostadal

doi:10.1016/j.forsciint.2021.110812

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

Forensic Sci Int. 2021 Apr 30:323:110812. doi: 10.1016/j.forsciint.2021.110812. Online ahead of print.

Authors

J Karasek¹, A Blankova², A Doubková³, T Pitasova³, D Nahalka³, T Bartes³, J Hladik⁴, T Adamek², T Jirasek², R Polasek⁵, P Ostadal⁶

Affiliations

¹ Hospital Liberec, Cardiology, Liberec, Czech Republic; Third Medical Faculty, Charles University, Prague, Czech Republic. Electronic address: jiri.karasek@nemlib.cz.
² Hospital Liberec, PATOS Centrum, Liberec, Czech Republic.
³ Third Medical Faculty, Charles University, Prague, Czech Republic.
⁴ University Hospital Kralovske Vinohrady, Department of Forensic Medicine, Prague, Czech Republic.
⁵ Hospital Liberec, Cardiology, Liberec, Czech Republic.
⁶ Hospital Na Homolce, Cardiology, Prague, Czech Republic.

PMID: 33965859
DOI: 10.1016/j.forsciint.2021.110812

Abstract

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.

Keywords: Autopsy; CPR related trauma; Mechanical chest device; Resuscitation.