Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-17T23:17:58.905Z Has data issue: false hasContentIssue false
  • English
  • Français

The Association between Cardiopulmonary Resuscitation in Out-of-Hospital Settings and Chest Injuries: A Retrospective Observational Study

Published online by Cambridge University Press:  08 March 2018

Wataru Takayama ,
Hazuki Koguchi ,
Akira Endo  and
Yasuhiro Otomo
Wataru Takayama*
Affiliation:
Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan The Shock Trauma and Emergency Medical Center, Matsudo City Hospital, Matsudo City, Chiba Prefecture, Japan
Hazuki Koguchi
Affiliation:
The Shock Trauma and Emergency Medical Center, Matsudo City Hospital, Matsudo City, Chiba Prefecture, Japan
Akira Endo
Affiliation:
Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
Yasuhiro Otomo
Affiliation:
Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
*
Correspondence: Wataru Takayama, MD Tokyo Medical and Dental University 1-5-45, Yushima, Bunkyo-ku Tokyo 113-0034, Japan E-mail: tak2accm@tmd.ac.jp
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The aim of this study was to assess the risk of cardiopulmonary resuscitation (CPR) performed in out-of-hospital settings for chest injuries in patients with out-of-hospital cardiac arrest (OHCA).

Methods

This retrospective, observational study was conducted in an emergency critical care medical center in Japan. Non-traumatic OHCA patients transferred to the hospital from April 2013 through August 2016 were analyzed. The outcome was defined by chest injuries related to CPR, which is composite of rib fractures, sternal fractures, and pneumothoraces. A multivariate logistic regression analysis was performed to assess the independent risk factors for chest injuries related to CPR. The threshold of out-of-hospital CPR duration that increased risk of chest injuries was also assessed.

Results

A total of 472 patients were identified, of whom 233 patients sustained chest injuries. The multivariate logistic regression model showed that the independent risk factors for chest injuries were age and out-of-hospital CPR duration (age: AOR=1.06 [95% CI, 1.04 to 1.07]; out-of-hospital CPR duration: AOR=1.03 [95% CI, 1.01 to 1.05]). In-hospital CPR duration was not an independent risk factor for chest injuries. When the duration of out-of-hospital CPR extended over 15 minutes, the likelihood of chest injuries increased; however, this association was not statistically significant.

Conclusions

Long duration of out-of-hospital CPR was an independent risk factor for chest injuries, possibly due to the difficulty of maintaining adequate quality of CPR. Further investigations to assess the efficacy of alternative CPR devices are expected in cases requiring long transportation times.

TakayamaW, KoguchiH, EndoA, OtomoY. The Association between Cardiopulmonary Resuscitation in Out-of-Hospital Settings and Chest Injuries: A Retrospective Observational Study. Prehosp Disaster Med. 2018;33(2):171–175.

Keywords

cardiopulmonary resuscitationchest compressionschest injuryout-of-hospital cardiac arrest
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 2 , April 2018 , pp. 171 - 175
Copyright
© World Association for Disaster and Emergency Medicine 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Conflicts of interest/funding: none

References

1. Hasselqvist-Ax, I, Riva, G, Herlitz, J, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015;372(24):2307-2315.Google Scholar
2. Ambulance Service Planning Office of Fire and Disaster Management Agency of Japan. Effect of first aid for cardiopulmonary arrest [in Japanese]. https://www.fdma.go.jp/neuter/topics/kyukyukyujo_genkyo/h28/01_kyukyu.pdf. Accessed June 21, 2017.Google Scholar
3. Kitamura, T, Kiyohara, K, Sakai, T, et al. Public-access defibrillation and out-of-hospital cardiac arrest in Japan. N Engl J Med. 2016;375(17):1649-1659.Google Scholar
4. Black, CJ, Busuttil, A, Robertson, C. Chest wall injuries following cardiopulmonary resuscitation. Resuscitation. 2004;63(3):339-343.CrossRefGoogle ScholarPubMed
5. Kleinman, ME, Brennan, EE, Goldberger, ZD, et al. Part 5: Adult Basic Life Support and cardiopulmonary resuscitation quality 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S414-S435.Google Scholar
6. Seiro, O, Takafumi, S, Yasuhiro, F, Jun, K, Hideki, T, Hirohisa, K. CPR related thoracic injury: a comparison of CPR guidelines between 2005 and 2010. Acute Med Surg. 2016;3(4):351-355.Google Scholar
7. Katoh, Y, Sugimoto, K, Yasuda, Y, Tanaka, S, Kumagawa, D, Tsunoda, N. A study regarding the improvement of chest compression quality in ambulances [in Japanese]. Annual Reports of Health, Physical Education, and Sport Science. 2010;29:53-56; https://kokushikan.repo.nii.ac.jp/index.php?action=pages_view_main&active_action=repository_action_common_download&item_id=4740&item_no=1&attribute_id=189&. Accessed June 21, 2017.Google Scholar
8. Masterson, S, Wright, P, O’Donnell, C, et al. Urban and rural differences in out-of-hospital cardiac arrest in Ireland. Resuscitation. 2015;91:42-47.Google Scholar
9. Seung, MK, You, JS, Lee, HS, Park, YS, Chung, SP, Park, I. Comparison of complications secondary to cardiopulmonary resuscitation between out-of-hospital cardiac arrest and in-hospital cardiac arrest. Resuscitation. 2016;98:64-72.CrossRefGoogle ScholarPubMed
10. Hickey, TB, Gill, GG, Seidman, MA, Webber, DL. CPR-associated right ventricular rupture in the setting of pulmonary embolism. CJEM. 2016;18(6):484-487.Google Scholar
11. Masahiro, N, Ayumu, Y, Noritsugu, M, Masaru, N, Masanori, O, Yusuke, Y. Right ventricular rupture induced by cardiopulmonary resuscitation. J Cardiol Cases. 2010;1:42-44.Google Scholar
12. Machii, M, Inaba, H, Nakae, H, Suzuki, I, Tanaka, H. Cardiac rupture by penetration of fractured sternum: a rare complication of cardiopulmonary resuscitation. Resuscitation. 2000;43(2):151-153.Google Scholar
13. Dupont, V, Rougé-Maillart, C, Gaudin, A, Jeanneteau, A, Jousset, N, Malbranque, S. Left diaphragm laceration due to cardiopulmonary resuscitation. J Forensic Sci. 2016;61(4):1135-1138.Google Scholar
14. Kashiwagi, Y, Sasakawa, T, Tampo, A, et al. Computed tomography findings of complications resulting from cardiopulmonary resuscitation. Resuscitation. 2015;88:86-91.Google Scholar
15. Wik, L, Kramer-Johansen, J, Myklebust, H, et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA. 2005;293(3):299-304.Google Scholar
16. Bonnes, JL, Brouwer, MA, Navarese, EP, et al. Manual cardiopulmonary resuscitation versus CPR including a mechanical chest compression device in out-of-hospital cardiac arrest: a comprehensive meta-analysis from randomized and observational studies. Ann Emerg Med. 2016;67(3):349-360.Google Scholar
17. Couper, K, Yeung, J, Nicholson, T, Quinn, T, Lall, R, Perkins, GD. Mechanical chest compression devices at in-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2016;103:24-31.Google Scholar
18. Lardi, C, Egger, C, Larribau, R, Niquille, M, Mangin, P, Fracasso, T. Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS 2): a forensic autopsy study. Int J Legal Med. 2015;129(5):1035-1042.CrossRefGoogle Scholar
19. Smekal, D, Lindgren, E, Sandler, H, Johansson, J, Rubertsson, S. CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device: a multi-center study of victims after unsuccessful resuscitation. Resuscitation. 2014;85(12):1708-1712.Google Scholar
20. Koga, Y, Fujita, M, Yagi, T, et al. Effects of mechanical chest compression device with a load-distributing band on post-resuscitation injuries identified by post-mortem computed tomography. Resuscitation. 2015;96:226-231.Google Scholar
Supplementary material: PDF

Takayama et al. supplementary material

Figure S1

Download Takayama et al. supplementary material(PDF)
PDF 454.9 KB