Abstract
Aim
There have been no direct comparisons of cardiopulmonary resuscitation (CPR)-related
injuries between those who die during CPR and those who survive to intensive care
unit (ICU) admission. This study aimed to compare the incidence, severity, and impact
on survival rate of these injuries and potential influencing factors.
Method
This retrospective multicenter study analyzed autopsy reports of patients who experienced
out-of-hospital cardiac arrest (OHCA) and were not admitted to hospital. CPR-related
injuries were compared to OHCA patients with clinical suspicion of CPR-related injury
confirmed on imaging when admitted to the ICU.
Results
A total of 859 out-of-hospital cardiac arrests (OHCA) were divided into 2 groups:
those who died during CPR and underwent autopsy (DEAD [n = 628]); and those who experienced
return of spontaneous circulation and admitted to the ICU (ICU [n = 231]). Multivariable
analyses revealed that independent factors of 30-day mortality included no bystander
arrest, cardiac etiology, no shockable rhythm, and CPR-related injury. Trauma was
independently associated with older age, bystander CPR, cardiac etiology, duration
of CPR, and no defibrillation. CPR-related injury occurred in 30 (13%) patients in
the ICU group and 547 (87%) in the DEAD group (p < 0.0001). Comparison of injuries
revealed that those in the DEAD group experienced more thoracic injuries, rib(s) and
sternal fractures, and fewer liver injuries compared to those in the ICU group, without
differences in injury severity.
Conclusion
CPR-related injuries were observed more frequently in those who died compared with
those who survived to ICU admission. Injury was an independent factor of 30-day mortality.
Keywords
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Article info
Publication history
Published online: January 04, 2022
Accepted:
December 30,
2021
Received in revised form:
December 29,
2021
Received:
November 22,
2021
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
