title: Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered.
abstract: OBJECTIVE
  This study aimed to establish the incidence, number and location of CPR-related skeletal chest injuries (SCI) and to investigate the influence of age, gender, changes in resuscitation guidelines and technique of resuscitation.
  
  
  METHODS
  We analysed SCI in 2148 patients who had undergone resuscitation for non-traumatic cardiac arrest, as shown by autopsies performed at the Institute of Forensic Medicine in Ljubljana in the period 2004-2013.
  
  
  RESULTS
  External cardiac massage caused SCI in 86% of males and in 91% of females; sternum fractures occurred in 59% of males and 79% of females, rib fractures in 77% of males and 85% of females and sternocostal separations in 33% of males and 12% of females. The average number of all SCI per person was thus almost the same in males and females: 10.95 vs. 10.96. The percentage of patients injured and the number of SCI increased with age. Changes in resuscitation guidelines were also identified as a factor contributing to the incidence and number of SCI. No adverse effect of the use of LUCAS was found.
  
  
  CONCLUSIONS
  It is generally considered that at least 1/3 of resuscitated patients sustain rib fractures and at least 1/5 sustains sternum fractures. However, our study showed that these injuries are much more frequent and that increased compression rate and depth cause more SCI. Since in the period 2011-2013 accompanying severe injuries occurred in only 1.85% of cases, the resuscitation technique has not yet jeopardised patient's safety, but further close monitoring is needed.
authors.affiliation: Institute of Forensic Medicine, Faculty of Medicine, University of Ljubljana, Korytkova 2, SI-1100 Ljubljana, Slovenia. Electronic address: eduardkralj@windowslive.com.
authors.forename: Eduard
authors.initials: E
authors.lastname: Kralj
authors.affiliation: Department for Anaesthesiology and Intensive Care, University Medical Centre Ljubljana, Zaloška 7, SI-1000 Ljubljana, Slovenia.
authors.forename: Matej
authors.initials: M
authors.lastname: Podbregar
authors.affiliation: Institute of Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1104 Ljubljana, Slovenia.
authors.forename: Nataša
authors.initials: N
authors.lastname: Kejžar
authors.affiliation: Institute of Forensic Medicine, Faculty of Medicine, University of Ljubljana, Korytkova 2, SI-1100 Ljubljana, Slovenia.
authors.forename: Jože
authors.initials: J
authors.lastname: Balažic
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods; D003933:Diagnosis; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011312:Pressure / Q000009:adverse effects*; D012253:Rib Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D017524:Slovenia / Q000453:epidemiology; D013249:Sternum / Q000293:injuries*; D013898:Thoracic Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology
keywords: Age; Cardiopulmonary resuscitation; ERC guidelines; Gender; LUCAS; Skeletal chest injuries