J Korean Soc Emerg Med.  2015 Oct;26(5):409-416. 10.0000/jksem.2015.26.5.409.

Factors Associated with Skeletal Chest Injuries Secondary to Cardiopulmonary Resuscitation of In-Hospital Cardiac Arrest Patients

• Cho JC
• Seo YW
• Kim G
• Lee KW
• Choi DH
• Jang TC

• KMID: 2191701
• DOI: http://doi.org/10.0000/jksem.2015.26.5.409

Abstract

PURPOSE
Rib and sternal fractures are common complications of chest compressions during cardiopulmonary resuscitation (CPR). The aim of this study is to investigate skeletal chest injuries following chest compressions and factors associated with skeletal chest injuries.
METHODS
A retrospective study was conducted for 10 years from January 2005 to February 2015. Skeletal chest injuries in patients who underwent computerized tomography (CT) after return of spontaneous circulation (ROSC) were analyzed. The exclusion criteria were patients with insufficient medical records, under 18 years old, traumatic cardiac arrest, and out-of-hospital cardiac arrest.
RESULTS
During the period 106 patients were included. The CT scan after ROSC showed that 47 patients (44.3%) had rib fractures, and 20 patients (18.9%) had sternal fractures. The rib fracture group showed higher age (73 vs 61, p<0.001), longer CPR time (10 vs 6 min, p<0.001), and higher incidence of sternal fracture (34% vs 6.8%, p<0.001). The sternal fracture group showed longer CPR time (10 vs 7, p<0.05) and higher incidence of rib fractures (80% vs 4.7%, p<0.001). In multivariate logistic regression analysis, age (OR 1.087; 95% CI 1.041 to 1.134, p<0.001), CPR time (OR 1.200; 95% CI 1.087 to 1.323, p<0.001), and sternal fracture (OR 4.524; 95% CI 1.259 to 16.697, p=0.021) showed significant association with rib fracture.
CONCLUSION
Rib and sternal fractures are frequent complications in patients who underwent CPR. In hospital cardiac arrest patients with older age, longer CPR time, and sternal fracture needed more precaution for rib fractures and other complications.

Keyword

Rib fractures; Sternal fractures; Cardiopulmonary resuscitation; Heart arrest

MeSH Terms

Cardiopulmonary Resuscitation*
Heart Arrest*
Humans
Incidence
Logistic Models
Medical Records
Out-of-Hospital Cardiac Arrest
Retrospective Studies
Rib Fractures
Ribs
Thoracic Injuries*
Thorax*
Tomography, X-Ray Computed