title: CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device: a multicentre study of victims after unsuccessful resuscitation.
abstract: OBJECTIVE
  The reported incidence of injuries due to cardiopulmonary resuscitation using manual chest compressions (manual CPR) varies greatly. Our aim was to elucidate the incidence of CPR-related injuries by manual chest compressions compared to mechanical chest compressions with the LUCAS device (mechanical CPR) in non-survivors after out-of-hospital cardiac arrest.
  
  
  METHODS
  In this prospective multicentre trial, including 222 patients (83 manual CPR/139 mechanical CPR), autopsies were conducted after unsuccessful CPR and the results were evaluated according to a specified protocol.
  
  
  RESULTS
  Among the patients included, 75.9% in the manual CPR group and 91.4% in the mechanical CPR group (p=0.002) displayed CPR-related injuries. Sternal fractures were present in 54.2% of the patients in the manual CPR group and in 58.3% in the mechanical CPR group (p=0.56). Of the patients in the manual CPR group, there were 64.6% with at least one rib fracture versus 78.8% in the mechanical CPR group (p=0.02). The median number of rib fractures among patients with rib fractures was 7 in the manual CPR group and 6 in the mechanical CPR group. No CPR-related injury was considered to be the cause of death.
  
  
  CONCLUSIONS
  In patients with unsuccessful CPR after out-of-hospital cardiac arrest, rib fractures were more frequent after mechanical CPR but there was no difference in the incidence of sternal fractures. No injury was deemed fatal by the pathologist.
authors.affiliation: Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, S-751 85 Uppsala, Sweden. Electronic address: dsmekal@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Smekal
authors.affiliation: Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, S-751 85 Uppsala, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Lindgren
authors.affiliation: Department of Surgical Sciences, Forensic Medicine, Uppsala University, S-751 85 Uppsala, Sweden; National Board of Forensic Medicine, S-751 40 Uppsala, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Sandler
authors.affiliation: Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, S-751 85 Uppsala, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Johansson
authors.affiliation: Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University, S-751 85 Uppsala, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Rubertsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D012151:Resuscitation / Q000009:adverse effects* / Q000379:methods; D012253:Rib Fractures / Q000453:epidemiology / Q000209:etiology*; D013548:Sweden / Q000453:epidemiology; D013898:Thoracic Injuries / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
keywords: Autopsy; Cardiopulmonary resuscitation (CPR); Complications; Injury; LUCAS™; Sudden cardiac arrest