Skeletal chest injuries secondary to cardiopulmonary resuscitation

Objective: To review the evidence on the incidence of rib and sternal fractures after conventional closed-chest compression in the treatment of cardiac arrest in adults and children, and after active compression–decompression cardiopulmonary resuscitation (ACD-CPR). Methods: Medline search and addit...

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Bibliographic Details
Published in:Resuscitation 2004-12, Vol.63 (3), p.327-338
Main Authors: Hoke, Robert Sebastian, Chamberlain, Douglas
Format: Article
Language:English
Subjects:
Active compression–decompression
Adult
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis
Cardiac arrest
Cardiac massage
Cardiopulmonary Resuscitation - adverse effects
Chest compression
Child
Child, Preschool
Compresión torácica
Compresión y descompresión activa
Compressão torácica
Compressão-descompressão activa
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Heart Arrest - therapy
Humans
Incidence
Infant
Intensive care medicine
Masage cardiaca
Masaje cardíaco
Medical sciences
Paragem cardiaca
Paro cardíaco
Rib Fractures - epidemiology
Rib Fractures - etiology
Sternum - injuries
Thoracic Injuries - epidemiology
Thoracic Injuries - etiology
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
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Summary:Objective: To review the evidence on the incidence of rib and sternal fractures after conventional closed-chest compression in the treatment of cardiac arrest in adults and children, and after active compression–decompression cardiopulmonary resuscitation (ACD-CPR). Methods: Medline search and additional review of the cited literature in the articles found. Results: Reports on conventional CPR in adults suggest an incidence of rib fractures ranging from 13 to 97%, and of sternal fractures from 1 to 43%. Reports on CPR in children suggest an incidence of rib fractures of 0–2%, and no sternal fractures. ACD-CPR has been reported as causing rib fractures in 4–87%, and sternal fractures in 0–93% of cases. Conclusions: Sound methodological studies on thoracic fractures due to chest compression do not exist and the available studies cannot be compared one with another. In infants and toddlers, manual CPR rarely causes skeletal chest injuries. In adults, sternal fractures occur in at least one-fifth and rib fractures as well as rib and/or sternal fractures in at least one-third of the patients during conventional CPR. There is no compelling evidence to show that an increased complication rate is associated with ACD-CPR. Rib or sternal fractures are unlikely to increase mortality, as they rarely cause severe internal organ damage. Further prospective studies are desirable to assess complications by post-mortem examinations that explicitly address them. In particular, clinical evaluation of mechanical CPR devices should be accompanied by a thorough assessment of the associated complications because data specific to this modality are not available. Objectivo:Rever os dados existentes relativos à incidência de fracturas esternais e costais após compressão torácica fechada convencional no tratamento da paragem cardíaca nos adultos e crianças, e após reanimação cardio–pulmonar com compressão-descompressão activa (ACD-CPR). Método:Pesquisa Medline e revisão adicional da literatura citada nos artigos encontrados. Resultados: Descrição da CPR convencional nos adultos sugere uma incidência de fracturas costais que varia de 13 a 97%, e de fracturas esternais de 1 a 43%. Descrição da CPR nas crianças sugere uma incidência de fracturas costais de 0–2%, e nenhuma fractura esternal. Tem sido descrito que a ACD-CPR causa fracturas costais em 4–87%, e fracturas esternais em 0–93% dos casos. Conclusão: Não há estudos metodológicos sobre as fracturas torácicas devidas à compressão
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2004.05.019