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Chest compression-associated injuries in cardiac arrest patients treated with manual chest compressions versus automated chest compression devices (LUCAS II) – a forensic autopsy-based comparison

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Abstract

The aim of this autopsy study was to investigate chest-compression associated injuries to the trunk in out-of-hospital and in-hospital non-traumatic cardiac arrest patients treated with automated external chest compression devices (ACCD; all with LUCAS II devices) versus exclusive manual chest compressions (mCC). In this retrospective single-center study, all forensic autopsies between 2011 and 2017 were included. Injuries following cardiopulmonary resuscitation (CPR) in patients treated with mCC or ACCD were investigated and statistically compared using a bivariate logistic regression. In the seven-year period with 4433 autopsies, 614 were analyzed following CPR (mCC vs. ACCD: n = 501 vs. n = 113). The presence of any type of trunk injury was correlated with longer resuscitation intervals (30 ± 15 vs. 44 ± 25 min, p < 0.05). In comparison with mCC, treatment with ACCD led to more frequent skin emphysema (5 vs 0%, p = 0.012), pneumothorax (6 vs. 1%, p = 0.008), lung lesions (19 vs. 4%, p = 0.008), hemopericardium (3 vs 1%, p = 0.025) and liver lesions (10 vs. 1%, p = 0.001), all irrespective of confounding aspects. Higher age and longer CPR durations statistically influenced frequency of sternal and rib fractures (p < 0.001). The mean number of fractured ribs did not vary significantly between the groups (6 ± 3 vs. 7 ± 2, p = 0.09). In this cohort with unsuccessful CPR, chest compression-related injuries were more frequent following ACCD application than in the mCC group, but with only minutely increased odds ratios. The severity of injuries did not differ between the groups, and no iatrogenic injury was declared by the forensic pathologist as being fatal. In the clinical routine after successful return of spontaneous circulation a computed tomography scan for CPR-associated injuries is recommended as soon as possible.

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Acknowledgments

The authors would like to thank Miss Lina Woydt for providing the anatomic sketch and Miss Aqeeda Singh for proofreading the paper as a native speaker.

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Author notes

  1. Benjamin Ondruschka and Christina Baier contributed equally to this work.

Authors and Affiliations

  1. Institute of Legal Medicine, University of Leipzig, Leipzig, Germany

    Benjamin Ondruschka, Christina Baier, Ronny Bayer & Jan Dreßler

  2. Department of Anatomy, University of Otago, Dunedin, New Zealand

    Niels Hammer

  3. Emergency Department, Heinrich Heine University, University Hospital, Duesseldorf, Germany

    Michael Bernhard

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  1. Benjamin Ondruschka
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Correspondence to Benjamin Ondruschka.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of the Medical Faculty of the University of Leipzig, Germany (code: 104/17-ek).

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Informed consent was waived due to the retrospective nature of the study.

Electronic supplementary material

Supplemental Fig. 1

Overview of the annual distribution of forensic autopsy cases at the Institute of Legal Medicine (University of Leipzig, Germany) with unsuccessful cardiopulmonary resuscitation (CPR) subdivided in annual numbers of manual chest compression (mCC) and automated chest compression device (ACCD) recorded in this study. All ACCD cases used a LUCAS II device. (JPEG 35 kb)

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Ondruschka, B., Baier, C., Bayer, R. et al. Chest compression-associated injuries in cardiac arrest patients treated with manual chest compressions versus automated chest compression devices (LUCAS II) – a forensic autopsy-based comparison. Forensic Sci Med Pathol 14, 515–525 (2018). https://doi.org/10.1007/s12024-018-0024-5

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  • DOI: https://doi.org/10.1007/s12024-018-0024-5

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