title: Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers.
abstract: In a prospective study of 38 cadavers of patients older than 18 without previous chest injury or cardiopulmonary resuscitation (CPR), active compression-decompression (ACD) resuscitation manoeuvres were performed to determine possible factors influencing sternal and/or rib fractures. ACD was performed for 60 s, with compression and decompression forces being continuously recorded. A stepwise logistic regression analysis was applied. Factors analyzed were age, gender, use of a compression cushion beneath the piston of the ACD device (Ambu CardioPump), and maximal compression and decompression forces. After ACD, the cadavers were autopsied and thoracic injuries were assessed. There was a significant correlation between sternal fractures and gender (P = 0.008), and between rib fractures and age (P = 0.008). Women were found to have a higher risk for sternal fractures, whereas older patients had a higher risk for rib fractures. Maximal compression force was another factor in sternal and/or rib fracture (P = 0.048). Even though a significantly higher incidence of sternal fractures was observed when the compression cushion was used (P = 0.045), inclusion of this variable in the regression analysis only marginally improved the prediction for correct classification of sternal fractures. In conclusion, when well controlled ACD-CPR is performed in cadavers, age is the most important factor determining the incidence of rib fracture. Sternal fractures were more common in female cadavers.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, The Leopold-Franzens-University of Innsbruck, Austria. michael.baubin@uibk.ac.at
authors.forename: M
authors.initials: M
authors.lastname: Baubin
authors.forename: W
authors.initials: W
authors.lastname: Rabl
authors.forename: K P
authors.initials: KP
authors.lastname: Pfeiffer
authors.forename: A
authors.initials: A
authors.lastname: Benzer
authors.forename: H
authors.initials: H
authors.lastname: Gilly
mesh_terms: D000367:Age Factors; D000368:Aged; D002102:Cadaver; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D012253:Rib Fractures / Q000209:etiology; D012737:Sex Factors; D013249:Sternum / Q000293:injuries; D013898:Thoracic Injuries / Q000209:etiology*