Injuries associated with mechanical chest compressions and active decompressions after out-of-hospital cardiac arrest: A subgroup analysis of non-survivors from a randomized study

Polina Petrovich; Per Olav Berve; Borghild Barth-Heyerdahl Roald; Håvard Wahl Kongsgård; Arne Stray-Pedersen; Jo Kramer-Johansen; Lars Wik

doi:10.1016/j.resplu.2023.100362

Injuries associated with mechanical chest compressions and active decompressions after out-of-hospital cardiac arrest: A subgroup analysis of non-survivors from a randomized study

Resusc Plus. 2023 Jan 31:13:100362. doi: 10.1016/j.resplu.2023.100362. eCollection 2023 Mar.

Authors

Polina Petrovich^{1

2}, Per Olav Berve^{1

3}, Borghild Barth-Heyerdahl Roald^{4

2}, Håvard Wahl Kongsgård¹, Arne Stray-Pedersen^{2

5}, Jo Kramer-Johansen^{1

2

3}, Lars Wik^{1

3}

Affiliations

¹ Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
³ Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway.
⁴ Department of Pathology, Oslo University Hospital, Norway.
⁵ Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, Norway.

Abstract

Background: Both skeletal and visceral injuries are reported after cardiopulmonary resuscitation (CPR). This subgroup analysis of a randomized clinical study describes/compares autopsy documented injury patterns caused by two mechanical, piston-based chest compression devices: standard LUCAS® 2 (control) and LUCAS® 2 with active decompression (AD, intervention) in non-survivors with out-of-hospital cardiac arrest (CA).

Method: We compared injuries documented by autopsies (medical/forensic) after control and intervention CPR based on written relatives consent to use patients' data. The pathologists were blinded for the device used. The cause of CA and injuries reported were based on a prespecified study autopsy template. We used Pearson's chi-squared test and logistic regression analysis with an alpha level of 0.05.

Results: 221 patients were included in the main study (April 2015-April 2017) and 207 did not survive. Of these, 114 (55%, 64 control and 50 intervention) underwent medical (N = 73) or forensic (N = 41) autopsy. The cause of CA was cardiac 53%, respiratory 17%, overdose/intoxication 14%, ruptured aorta 10%, neurological 1%, and other 5%. There were no differences between control and intervention in the incidence of rib fractures (67% vs 72%; p-value = 0.58), or sternal fractures (44% vs 48%; p-value = 0.65), respectively. The most frequent non-skeletal complication was bleeding (26% of all patients) and intrathoracic was the most common location. Ten of the 114 patients had internal organ injuries, where lungs were most affected.

Conclusion: In non-survivors of OHCA patients, the most frequent cause of cardiac arrest was cardiogenic. Skeletal and non-skeletal fractures/injuries were found in both control and intervention groups. Bleeding was the most common non-skeletal complication. Internal organ injuries were rare.

Keywords: Autopsies; CPR; Cardiopulmonary resuscitation; Cause of cardiac arrest; Mechanical chest compression device; Skeletal injuries; Visceral injuries.