Effects of mechanical chest compression device with a load-distributing band on post-resuscitation injuries identified by post-mortem computed tomography.
OBJECTIVE
To determine the effects of cardiopulmonary resuscitation (CPR) with AutoPulse™ (LDB-CPR) on post-resuscitation injuries identified by post-mortem computed tomography (PMCT). AutoPulse™ is a novel mechanical chest-compression device with a load-distributing band (LDB) that may affect post-resuscitation injury identified by PMCT.


METHODS
We conducted a retrospective cohort study of non-traumatic adult out-of-hospital cardiac arrest patients whose death was confirmed in our emergency department between October 2009 and September 2014. Patients were divided according to whether LDB-CPR (LDB-CPR group) or manual CPR only (manual CPR only group) was performed. The background characteristics and post-resuscitation injuries identified by PMCT were compared between both groups. Logistic regression was used to identify risk factors for posterior rib fracture and abdominal injury.


RESULTS
Overall, 323 patients were evaluated, with 241 (74.6%) in the LDB-CPR group. The total duration of CPR was significantly longer in the LDB-CPR group than in the manual CPR only group. Posterior rib fracture, hemoperitoneum, and retroperitoneal hemorrhage were significantly more frequent in the LDB-CPR group. The frequencies of anterior/lateral rib and sternum fracture were similar in both groups. Pneumothorax tended to be more frequent in the LDB-CPR group, although not significantly. LDB-CPR was an independent risk factor for posterior rib fracture (odds ratio 30.57, 95% confidence interval 4.15-225.49, P=0.001) and abdominal injury (odds ratio 4.93, 95% confidence interval 1.88-12.95, P=0.001).


CONCLUSIONS
LDB-CPR was associated with higher frequencies of posterior rib fracture and abdominal injury identified by PMCT. PMCT findings should be carefully examined after LDB-CPR.
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan.
Yasutaka
Y
Koga
Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan. Electronic address: motoki-ygc@umin.ac.jp.
Motoki
M
Fujita
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan.
Takeshi
T
Yagi
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan.
Takashi
T
Nakahara
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan.
Takashi
T
Miyauchi
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan.
Kotaro
K
Kaneda
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan.
Yoshikatsu
Y
Kawamura
Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Yasutaka
Y
Oda
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan; Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Ryosuke
R
Tsuruta
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D004632:Emergency Medical Services; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006336:Heart Massage / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012253:Rib Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D013909:Thorax; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
Abdominal injury; Cardiopulmonary resuscitation; Load-distributing band; Post-mortem computed tomography; Rib fracture