title: Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study.
abstract: BACKGROUND
  The purpose of this study was to identify the relationship between the deeper and faster chest compressions suggested by the 2010 cardiopulmonary resuscitation guidelines and complications arising from chest compressions, using multi-detector computed tomography.
  
  
  METHODS
  We performed a retrospective analysis of prospective registry data. This study was conducted with in- and out-of-hospital cardiac arrest patients who underwent successful resuscitation in the emergency departments of two academic tertiary care centres from October 2006 to September 2010 (pre-2010 group) and from October 2011 to September 2015 (post-2010 group). We examined chest injuries related to chest compressions, classified as follows: rib fracture, sternal fracture, and other uncommon complications.
  
  
  RESULTS
  We enrolled 185 patients in this study. The most frequent complication to occur in both groups was rib fracture: 27 (62.8%) and 112 (78.9%) patients in the pre-2010 and post-2010 groups, respectively (p = 0.03). However, we observed no statistical differences in sternum fracture, the second most common complication (p = 0.80). Retrosternal and mediastinal haematoma were not reported in the pre-2010 group but 13 patients (9.1%) in the post-2010 group were reported to have haematoma (p = 0.04). Nine serious, life-threatening complications occurred, all in the post-2010 group. Among the younger group (less than 65 years old), 8 (38.1%) patients in the pre-2010 group and 40 (64.5%) in the post-2010 group sustained rib fractures.
  
  
  CONCLUSIONS
  The deeper and faster chest compressions for enhancing ROSC are associated with increased occurrence of complications. Additional studies are needed to compensate for the limitations of our study design.
  
  
  CONCLUSIONS
  This study found that the 2010 guidelines, recommending deeper and faster chest compressions, led to an increased proportion of rib fractures and retrosternal and mediastinal haematoma.
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Beom
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
authors.forename: Je Sung
authors.initials: JS
authors.lastname: You
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
authors.forename: Min Joung
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Gyeonggi-Do, Republic of Korea.
authors.forename: Min Kyung
authors.initials: MK
authors.lastname: Seung
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea. pys0905@yuhs.ac.
authors.forename: Yoo Seok
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Chung
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
authors.forename: Sung Phil
authors.initials: SP
authors.lastname: Chung
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
authors.forename: Incheol
authors.initials: I
authors.lastname: Park
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004636:Emergency Service, Hospital; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000009:adverse effects*; D006801:Humans; D061330:Multidetector Computed Tomography; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000209:etiology*
keywords: Cardiopulmonary resuscitation guideline; Chest compression; Complication; Multi-detector computed tomography