The utility of computed tomography to evaluate thoracic complications after cardiopulmonary resuscitation

Abstract

Background: Cardiopulmonary resuscitation (CPR) in adults following non-traumatic out of hospital cardiac arrest (OHCA) can cause thoracic complications including rib fractures, sternal fractures, and pneumothorax. Post-CPR complication rates are poorly studied and the optimum imaging modality to detect these complications post-resuscitation has not been established.

Methods: We performed a retrospective review of adult patients transported to a single, urban, academic hospital following atraumatic OHCA between September 2015 and January 2020. Patients who achieved sustained return of spontaneous circulation (ROSC) and who underwent computed tomography (CT) imaging of the chest following radiographic chest x-ray were included in the analyses. Patient demographics and prehospital data were collected. Descriptive statistics and multivariate logistic regression analysis were performed. Sensitivity and specificity of chest x-ray for the detection of thoracic injury in this population were estimated.

Results: 786 non-traumatic OHCA patients were transported to the ED, 417 of whom obtained sustained ROSC and were admitted to the hospital (53%). 137 (32.9%) admitted patients underwent CT imaging of the chest in the ED. Of these imaged patients median age was 62 years old (IQR 53-70) with 54.0% female and 38.0% of patients having received bystander CPR. 40/137 (29.2%) patients had skeletal fractures noted on CT imaging and 12/137 (8.8%) had pneumothorax present on CT imaging. X-ray yielded a sensitivity of 7.5% for rib fracture and 50% for pneumothorax with a specificity of 100% for both. Logistic regression analysis revealed no significant association between age, sex, bystander CPR, or resuscitation length with thoracic fractures or pneumothorax.

Conclusions: Complications from OHCA CPR were high with 29.2% of CT imaged patients having rib fractures and 8.8% having pneumothoraces. X-ray had poor sensitivity for these post-resuscitation complications. Post-CPR CT imaging of the chest should be considered for detecting post-CPR complications.

Keywords: Chest compression; Out of hospital CPR; Pneumothorax; Return of spontaneous circulation.

Fig. 1

Traumatic thoracic complications in out of hospital cardiopulmonary resuscitation at a single urban academic center following sustained ROSC and CT imaging of the chest.

Fig. 2

Characteristic bent or angulated appearance of a buckle fracture in a patient who underwent CPR and achieved return of spontaneous circulation. The patient was found to have a incomplete fracture of the mediastinum as well as bilateral anterolateral rib buckling with several displaced rib fractures not detected on chest x-ray imaging.