Association of multiple rib fractures with the frequency of pneumonia in the post-resuscitation period

Yasuyuki Kawai; Keisuke Takano; Keita Miyazaki; Koji Yamamoto; Yusuke Tada; Hideki Asai; Naoki Maegawa; Yasuyuki Urisono; Keigo Saeki; Hidetada Fukushima

doi:10.1016/j.resplu.2022.100267

Association of multiple rib fractures with the frequency of pneumonia in the post-resuscitation period

Resusc Plus. 2022 Jul 1:11:100267. doi: 10.1016/j.resplu.2022.100267. eCollection 2022 Sep.

Authors

Affiliations

¹ Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan.
² Department of Epidemiology, Nara Medical University School of Medicine, Nara, Japan.

Abstract

Purpose: Successful cardiopulmonary resuscitation is associated with a high incidence of chest wall injuries. However, few studies have examined chest wall injury as a risk factor for respiratory complications after cardiopulmonary resuscitation. Therefore, herein, we investigated the association of multiple rib fractures on the incidence of post-resuscitation pneumonia.

Methods: This single-centre retrospective cohort study enrolled adult, nontraumatic, out-of-hospital cardiac arrest patients who maintained circulation for more than 48 h between June 2015 and May 2019. Rib fractures were evaluated by computed tomography on the day of hospital admission. The association with newly developed pneumonia within 7 days of hospitalisation was analysed using a Fine-Gray proportional hazards regression model adjusted for the propensity score of multiple rib fractures estimated from age, sex, presence of witnessed status, bystander CPR, initial rhythm, and total CPR time and for previously reported risk factors for pneumonia (therapeutic hypothermia and prophylactic antibiotics).

Results: Overall, 683 patients with out-of-hospital cardiac arrest were treated; 87 eligible cases were enrolled for analysis. Thirty-two (36.8%) patients had multiple rib fractures identified on computed tomography, and 35 (40.2%) patients developed pneumonia. The presence of multiple rib fractures was significantly associated with a higher incidence of pneumonia, consistently both with and without adjustment for background factors (unadjusted hazard ratio 4.63, 95% confidence interval: 2.35-9.13, p < 0.001; adjusted hazard ratio 4.03, 95% confidence interval: 2.08-7.82, p < 0.001).

Conclusions: Multiple rib fractures are independently associated with the development of pneumonia after successful resuscitation.

Keywords: CA, cardiac arrest; CPR, cardiopulmonary resuscitation; CT, computed tomography; Cardiopulmonary resuscitation; HR, hazard ratio; OHCA, out-of-hospital cardiac arrest; Out-of-hospital cardiac arrest; Pneumonia; ROSC, return of spontaneous circulation; Rib fractures; SSRF, surgical stabilisation of rib fractures; TH, therapeutic hypothermia; Thoracic injury.