title: Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray.
abstract: OBJECTIVE
  Fractured ribs and sternum are frequent complications of thoracic compression during CPR in adults. This study was conducted to determine whether findings of plain chest radiography (CXR) correlate with post-mortem findings in patients who underwent cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest.
  
  
  METHODS
  CXR findings and autopsy results of CPR-related chest injuries comprising rib and sternum fractures were compared prospectively in 19 patients.
  
  
  RESULTS
  Fractures were diagnosed in nine of 19 patients by means of radiology and in 18 of 19 patients by autopsy (rib fractures in 6/19 versus 17/19, P=0.002; sternum fractures in 5/19 versus in 9/19, P=0.227. The total number of isolated bone fractures detected by CXR was 18 (12 rib and six sternum fractures) and by autopsy 92 (83 rib and nine sternum fractures). The majority of rib fractures was located in the anterior part of the thoracic cage. Sternum fractures predominantly occurred in the lower third. Eight of 19 patients received either thrombolytic or antithrombotic treatment during CPR but no major bleeding complication associated with CPR was detected by autopsy.
  
  
  CONCLUSIONS
  The findings of this study indicate that fractures associated with CPR are underreported in conventional radiographic investigations. No major bleeding complications related to CPR-associated fractures was detected.
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, The Leopold Franzens University of Innsbruck, 35, Anichstr., A-6020 Innsbruck, Austria. michael.baubin@uibk.ac.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lederer
authors.forename: Dieter
authors.initials: D
authors.lastname: Mair
authors.forename: Walter
authors.initials: W
authors.lastname: Rabl
authors.forename: Michael
authors.initials: M
authors.lastname: Baubin
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D001344:Autopsy; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods; D004632:Emergency Medical Services; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011336:Probability; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D017678:Sex Distribution; D013249:Sternum / Q000293:injuries*