Korean J Anesthesiol.  1981 Dec;14(4):459-464.

Flail Chest Resulting from Cardiopulmonary Resuscitation

• Jeon JK
• Lee JK

Abstract

The term flail chest is used to describe the condition in which a portion of the chest wall moves in a direction opposite to the rest of the thorax. This condition generally results from multiple rib fractures caused by external thoracic compression. Most characteristically, this occurs as a result of bilateral rib fractures after a steering-wheel injury or a crushing chest injury. In this article, 3 cases of flail chest developed following cardiopulmonary resuscitation showing a typical paradoxical respiration. The first case, a 69 year old male, had cardiac arrest during direct laryngoscopy in the operating room and was successfully resuscitated with external heart compression. He was then found to have separation of all costochondral junctions with paradoxical respirations. He was intubated and his respirations were controlled with a volume controlled respirator. Two days later, surgical traction was applied to his sternum, and was maintained for three weeks. He went home in good health after removal of the traction. The second case, a 48 year old male in hypovolemic shock, had a cardiac arrest postoperatively. He was resuscitated and then found to have paradoxical respiration which was controlled by a volume controlled respirator. He died of brain damage resulting from insufficient C.P.R. on the third day after the incident. The third case, a 57 year old male, was admitted to this institution from a local clinic with a flail chest as a result of costochondral separation after C.P.R. had been performed. He was intubated and his respirations were controlled by a volume setting respirator. On the second day following admission, traction was applied surgically to his sternum, thereafter he had normal respirations. However, his consciousness never returned and he died fo suspected brain damage fifteen days following admission. Cardiopulmonary resuscitation is vitally important to maintain artificial circulation and respiration. Cardiac compression must be sufficient to force blood out of the ventricles between the sternum and the spin(Fig.3). Even though the most common complication of C.P.R. is rib fractures, a sufficient heart compression is still the most important factor. However, rib fractures may be avoided by proper placement of the hands over the sternum during manual heart compression(Fig. 2). Once flail chest occurs, it should be actively treated by a volume controlled respirator and traction.

MeSH Terms

Aged
Brain
Cardiopulmonary Resuscitation*
Consciousness
Flail Chest*
Hand
Heart
Heart Arrest
Humans
Laryngoscopy
Male
Middle Aged
Operating Rooms
Respiration
Rib Fractures
Shock
Sternum
Thoracic Injuries
Thoracic Wall
Thorax
Traction
Ventilators, Mechanical