Open Access Emergency Medicine (Oct 2022)

Traumatic Injuries Following Mechanical versus Manual Chest Compression

  • Saleem S,
  • Sonkin R,
  • Sagy I,
  • Strugo R,
  • Jaffe E,
  • Drescher M,
  • Shiber S

Journal volume & issue
Vol. Volume 14
pp. 557 – 562

Abstract

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Safwat Saleem,1 Roman Sonkin,2 Iftach Sagy,3,4 Refael Strugo,2 Eli Jaffe,2 Michael Drescher,1,5 Shachaf Shiber1,5 1Emergency Department, Rabin Medical Center – Beilinson Hospital, Petach-Tikva, Israel; 2Magen David Adom (Israel National Emergency Medical Service), Ramat Gan, Israel; 3Rheumatology Unit, Soroka Hospital, Be’er Sheva, Beer Sheva, Israel; 4Faculty of Medicine, University of the Negev, Be’er Sheva, Israel; 5Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelCorrespondence: Shachaf Shiber, Department of Emergency Medicine, Rabin Medical Center – Beilinson Hospital, 39 Jabotinski St, Petach Tikva, 4941492, Israel, Tel +972-54-4699750, Email [email protected]: 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: cardiopulmonary resuscitation, CPR, fractures, active compression-decompression device, ACD

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