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. 2022 Oct 4:14:557-562.
doi: 10.2147/OAEM.S374785. eCollection 2022.

Traumatic Injuries Following Mechanical versus Manual Chest Compression

Safwat Saleem  1 , Roman Sonkin  2 , Iftach Sagy  3   4 , Refael Strugo  2 , Eli Jaffe  2 , Michael Drescher  1   5 , Shachaf Shiber  1   5
Affiliations

Traumatic Injuries Following Mechanical versus Manual Chest Compression

Safwat Saleem et al. Open Access Emerg Med. .

Abstract

Objective: Survival after out-of-hospital cardiac arrest (OHCA) depends on multiple factors, mostly quality of chest compressions. Studies comparing manual compression with a mechanical active compression-depression device (ACD) have yielded controversial results in terms of outcomes and injury. The aim of the present study was to determine whether out-of-hospital ACD cardiopulmonary resuscitation (CPR) use is associated with more skeletal fractures and/or internal injuries than manual compression, with similar duration of cardiopulmonary resuscitation (CPR) between the groups.

Methods: The cohort included all patients diagnosed with out-of-hospital cardiac arrest (OHCA) at a tertiary medical center between January 2018 and June 2019 who achieved return of spontaneous circulation (ROSC). The primary outcome measure was the incidence of skeletal fractures and/or internal injuries in the two groups. Secondary outcome measures were clinical factors contributing to skeletal fracture/internal injuries and to achievement of ROSC during CPR.

Results: Of 107 patients enrolled, 45 (42%) were resuscitated with manual chest compression and 62 (58%) with a piston-based ACD device (LUCAS). The duration of chest compression was 46.0 minutes vs. 48.5 minutes, respectively (p=0.82). There were no differences in rates of ROSC (53.2% vs.50.8%, p=0.84), cardiac etiology of OHCA (48.9% vs.43.5%, p=0.3), major complications (ribs/sternum fracture, pneumothorax, hemothorax, lung parenchymal damage, major bleeding), or any complication (20.5% vs.12.1%, p=0.28). On multivariate logistic regression analysis, factors with the highest predictive value for ROSC were cardiac etiology (OR 1.94;CI 2.00-12.94) and female sex (OR 1.94;CI 2.00-12.94). Type of arrhythmia had no significant effect. Use of the LUCAS was not associated with ROSC (OR 0.73;CI 0.34-2.1).

Conclusion: This is the first study to compare mechanical and manual out-of-hospital chest compression of similar duration to ROSC. The LUCAS did not show added benefit in terms of ROSC rate, and its use did not lead to a higher risk of traumatic injury. ACD devices may be more useful in cases of delayed ambulance response times, or events in remote locations.

Keywords: ACD; CPR; active compression-decompression device; cardiopulmonary resuscitation; fractures.

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Conflict of interest statement

The authors report no conflict of interest.

References

    1. Steen S, Liao Q, Pierre L, Paskevicius A, Sjöberg T. The critical importance of minimal delay between chest compressions and subsequent defibrillation: a haemodynamic explanation. Resuscitation. 2003;58(3):249‒258. doi:10.1016/s0300-9572(03)00265-x - DOI - PubMed
    1. Sato Y, Weil MH, Sun S, et al. Adverse effects of interrupting precordial compression during cardiopulmonary CPR. Crit Care Med. 1997;25(5):733‒736. doi:10.1097/00003246-199705000-00005 - DOI - PubMed
    1. Paradis NA, Martin GB, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary CPR. JAMA. 1990;263(8):1106. doi:10.1001/jama.1990.03440080084029 - DOI - PubMed
    1. Eftestøl T, Sunde K, Andreas Steen P. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation. 2002;105(19):2270‒2273. doi:10.1161/01.CIR.0000016362.42586.FE - DOI - PubMed
    1. Olasveengen TM, Wik L, Steen PA. Quality of cardiopulmonary CPR before and during transport in out-of-hospital cardiac arrest. Resuscitation. 2008;76(2):185‒190. doi:10.1016/j.resuscitation.2007.07.001 - DOI - PubMed