Intra-thoracic injuries associated with cardiopulmonary resuscitation - Frequent and serious.
The aim of the study was to evaluate prevalence, seriousness and risk factors of intra-thoracic injuries (ITI) injuries associated with CPR in non-survivors after out-of-hospital cardiac arrest.



This was a prospective forensic autopsy cohort study conducted in a single institution. Pathologists recorded autopsy data using standardized protocol which contained data from external and internal examination of the body focused on ITI.



In total, 80 persons were included in this study. CPR-associated injuries were found in 93.7% of cases; majority of injuries were skeletal chest fractures (rib fractures in 73.7%, sternal fractures in 66.3%). ITI were identified in 41.2% of cases. Contusion of at least one lung lobe was found in 31.2%, lung laceration in 2.5%, and hemothorax in 5.0% of cases. Transmural heart contusion was identified in 17.5% of cases; hemopericard on the grounds of right atrium rupture of aortic rupture was revealed in 8.7% of cases. Risk factor analysis did not show any statistically significant correlation between ITI and any of general data (age, gender, BMI, cause of death, season of the year or location where the body was found) or CPR specifications (type and duration of CPR, manner of chest compressions). A strong correlation between ITI and skeletal chest fractures was proven.



ITI present frequent and serious complications of unsuccessful CPR. ITI could contribute to the death only provided the fact that ROSC had been achieved. Correct performance of chest compressions according to guidelines is the best way to avoid ITI.
Department of Forensic Medicine, University Hospital Ostrava, 17.listopadu 1790, Ostrava 70852, Czech Republic; Department of Intensive Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic. Electronic address: dr.rudinska@seznam.cz.
Lucia
L
Ihnát Rudinská
Department of Forensic Medicine, University Hospital Hradec Králové, Sokolská 581, Hradec Králové 500 05, Czech Republic.
Petr
P
Hejna
Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic; Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava 70852, Czech Republic.
Peter
P
Ihnát
Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic.
Hana
H
Tomášková
Department of Forensic Medicine, University Hospital Ostrava, 17.listopadu 1790, Ostrava 70852, Czech Republic; Department of Intensive Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic.
Margita
M
Smatanová
Department of Forensic Medicine, University Hospital Ostrava, 17.listopadu 1790, Ostrava 70852, Czech Republic; Department of Intensive Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic.
Igor
I
Dvořáček
D000368:Aged; D001344:Autopsy / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000401:mortality; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000453:epidemiology*
Autopsy study; Injury; Intra-thoracic; Resuscitation; Risk factors; Trauma