Trauma associated with cardiopulmonary resuscitation based on autopsy reports after the 2015 ERC guidelines

ElsevierVolume 61, November 2022, Pages 81-86The American Journal of Emergency MedicineHighlights•

The Impact of the 2015 European Resuscitation Council guidelines was evaluated.

Autopsy reports of those who underwent cardiopulmonary resuscitation were analyzed.

Cardiopulmonary resuscitation-related injuries were objectively assessed.

No differences between resuscitation by bystander(s) or compared to professionals.

Compared to the 2010 guidelines, more injuries, but fewer were life-threatening.

AbstractIntroduction

Cardiopulmonary resuscitation (CPR)-related injuries have not been assessed since the 2015 Resuscitation Guidelines were established.

Aim

To describe the incidence and severity of CPR-related injuries, and to evaluate the impact of the 2015 European Resuscitation Council (ERC) guidelines on the objective assessment of injuries.

Methods

This multicenter, retrospective study analyzed autopsy reports of patients who underwent CPR. The most severe injuries were objectively assessed using the Abbreviated Injury Scale (AIS) and all injuries were summarized according to the New Injury Severity Score (NISS).

Results

Among 628 autopsy reports analyzed, patient characteristics and case details were distributed as follows: male sex, 71.1%; median age, 67 years; out-of-hospital cardiac arrest, 89.2%; bystander CPR, 56.8%. CPR-related injuries included: rib(s) 94.6%; lung(s), 9.9%; sternum, 62.4%; liver, 2.5%; and spleen, 1.8%. The incidence of bystander-provided CPR and severity of injury were similar to CPR provided only by professionals. There were no difference between mechanical and manual compressions. Females were older (p = 0.0001) and, although the frequency of their injuries was similar to males, they were significantly more severe (p = 0.01). Patients with life-threatening injury exhibited a baseline profile similar to those without injury . The median score (according to AIS) of the most severe injury was 3 and the median of summary of injuries was 13 according to the NISS–low risk of fatal injury.

Conclusion

CPR-related injuries occurred frequently, although those that were life-threatening accounted for only 3% of cases. There were no differences between patients who were resuscitated by bystander(s) or by professionals and no differences between mechanical chest devices or manual resuscitation. Compared with a study based on the 2010 guidelines, similar injuries were found, but with more rib fractures, less visceral organ damage, and fewer life-threatening injuries.

Keywords

Cardiac arrest

Resuscitation

CPR related trauma

ERC guidelines

AbbreviationsAIS

Abbreviated Injury Scale

CPR

cardiopulmonary resuscitation

eCRF

electronic case report form

ERC

European Resuscitation Council

IHCA

in-hospital cardiac arrest

OCHA

out-of-hospital cardiac arrest

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