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European Radiology

, Volume 28, Issue 10, pp 4122–4127 | Cite as

Use of whole body CT to detect patterns of CPR-related injuries after sudden cardiac arrest

  • Gregor M. Dunham
  • Alexandre Perez-Girbes
  • Ferdia Bolster
  • Kellie Sheehan
  • Ken F. Linnau
Emergency Radiology
  • 333 Downloads

Abstract

Aims and objectives

We have recently implemented a dedicated sudden cardiac arrest (SCA) - whole-body computed tomography (WBCT) protocol to evaluate SCA patients with return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR). The aim of this study is to evaluate the number and pattern of CPR-related injuries in ROSC patients with SCA-WBCT.

Methods and materials

Single-centre retrospective review of 39 patients (13 female; 20 male, mean age 51.8 years) with non-traumatic, out-of-hospital SCA and ROSC and evaluation with dedicated SCA-WBCT over a 10-month period.

Results

In-hospital mortality was 54%. CPR-related injuries were detected in 85% (33/39).

Chest injuries were most common on WBCT: 85% (33) subjects had rib fractures (mean of 8.5 fractures/subject); 31% (12) sternal fractures; 13% (5) mediastinal haematoma; 10% (4) pneumothorax; 8% (3) pneumomediastinum and 3% (1) haemothorax. Three subjects (8%) had abdominal injuries on WBCT, including one hepatic haematoma with active haemorrhage.

Conclusion

CPR-related injuries on WBCT after ROSC are common, with serial rib fractures detected most commonly. An unexpectedly high rate of abdominal injuries was detected on SCA-WBCT. Radiologists need to be attuned to the spectrum of CPR-related injuries in WBCT, including abdominal injuries and subtle rib fractures.

Key Points

CPR frequently causes injuries.

Radiologists should be aware of the spectrum of CPR related injuries.

Rib fractures are frequent and radiologic findings often subtle.

Clinically unexpected abdominal injuries may be present.

Keywords

Cardiopulmonary resuscitation Tomography, X-Ray computed Wounds and injuries Emergencies Radiology 

Notes

Acknowledgements

Scientific paper was presented at ECR 2017 (17-P-1685-ECR).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Ken F. Linnau, MD, MS.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

This study was partially supported by the Institute of Translational Health Science (ITHS) (grant UL1 RR025014 from NCRR/NIH).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution.

References

  1. 1.
    Kleinman ME, Brennan EE, Goldberger ZD, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. In: Vol 132. American Heart Association, Inc.; 2015:S414-S435Google Scholar
  2. 2.
    Olds K, Byard RW, Langlois NEI (2015) Injuries associated with resuscitation - an overview. J Forensic Leg Med 33:39–43CrossRefGoogle Scholar
  3. 3.
    Kashiwagi Y, Sasakawa T, Tampo A et al (2015) Computed tomography findings of complications resulting from cardiopulmonary resuscitation. Resuscitation 88:86–91CrossRefGoogle Scholar
  4. 4.
    Boland LL, Satterlee PA, Hokanson JS, Strauss CE, Yost D (2015) Chest compression injuries detected via routine post-arrest care in patients who survive to admission after out-of-hospital cardiac arrest. Prehosp Emerg Care 19:23–30CrossRefGoogle Scholar
  5. 5.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381CrossRefGoogle Scholar
  6. 6.
    Moore EE, Shackford SR, Pachter HL et al (1989) Organ injury scaling: spleen, liver, and kidney. J Trauma 29:1664–1666CrossRefGoogle Scholar
  7. 7.
    Hoke RS, Chamberlain D (2004) Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation 63:327–338CrossRefGoogle Scholar
  8. 8.
    Kim MJ, Park YS, Kim SW et al (2013) Chest injury following cardiopulmonary resuscitation: a prospective computed tomography evaluation. Resuscitation 84:361–364CrossRefGoogle Scholar
  9. 9.
    Kim EY, Yang HJ, Sung YM et al (2011) Multidetector CT findings of skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation 82:1285–1288CrossRefGoogle Scholar
  10. 10.
    Hellevuo H, Sainio M, Nevalainen R et al (2013) Deeper chest compression - more complications for cardiac arrest patients? Resuscitation 84:760–765CrossRefGoogle Scholar
  11. 11.
    Nichol G, Thomas E, Callaway CW et al (2008) Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 300:1423–1431CrossRefGoogle Scholar
  12. 12.
    Ringl H, Lazar M, Töpker M et al (2015) The ribs unfolded - a CT visualization algorithm for fast detection of rib fractures: effect on sensitivity and specificity in trauma patients. Eur Radiol 25:1865–1874CrossRefGoogle Scholar
  13. 13.
    Bulger EM, Arneson MA, Mock CN, Jurkovich GJ (2000) Rib fractures in the elderly. J Trauma 48:1040–1046. discussion1046–7.CrossRefGoogle Scholar
  14. 14.
    Sirmali M, Türüt H, Topçu S et al (2003) A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg 24:133–138CrossRefGoogle Scholar
  15. 15.
    Kralj E, Podbregar M, Kejžar N, Balažic J (2015) Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered. Resuscitation 93:136–141CrossRefGoogle Scholar
  16. 16.
    Miller AC, Rosati SF, Suffredini AF, Schrump DS (2014) A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries. Resuscitation 85:724–731CrossRefGoogle Scholar
  17. 17.
    Koga Y, Fujita M, Yagi T et al (2015) Effects of mechanical chest compression device with a load-distributing band on post-resuscitation injuries identified by post-mortem computed tomography. Resuscitation 96:226–231CrossRefGoogle Scholar
  18. 18.
    Meron G, Kurkciyan I, Sterz F et al (2007) Cardiopulmonary resuscitation-associated major liver injury. Resuscitation 75:445–453CrossRefGoogle Scholar
  19. 19.
    Krischer JP, Fine EG, Davis JH, Nagel EL (1987) Complications of cardiac resuscitation. Chest 92:287–291CrossRefGoogle Scholar
  20. 20.
    Cho SH, Kim EY, Choi SJ et al (2013) Multidetector CT and radiographic findings of lung injuries secondary to cardiopulmonary resuscitation. Injury 44:1204–1207CrossRefGoogle Scholar
  21. 21.
    Lardi C, Egger C, Larribau R, Niquille M, Mangin P, Fracasso T (2015) Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS2): a forensic autopsy study. Int J Legal Med 129:1035–1042CrossRefGoogle Scholar
  22. 22.
    Smekal D, Lindgren E, Sandler H, Johansson J, Rubertsson S (2014) CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device: a multicentre study of victims after unsuccessful resuscitation. Resuscitation 85:1708–1712CrossRefGoogle Scholar
  23. 23.
    Bonnes JL, Brouwer MA, Navarese EP et al (2016) Manual cardiopulmonary resuscitation versus CPR including a mechanical chest compression device in out-of-hospital cardiac arrest: a comprehensive meta-analysis from randomized and observational studies. Ann Emerg Med 67:349–360.e3CrossRefGoogle Scholar
  24. 24.
    Wirth S, Körner M, Treitl M et al (2009) Computed tomography during cardiopulmonary resuscitation using automated chest compression devices--an initial study. Eur Radiol 19:1857–1866CrossRefGoogle Scholar
  25. 25.
    Fosse E, Lindberg H (1996) Left ventricular rupture following external chest compression. Acta Anaesthesiol Scand 40:502–504CrossRefGoogle Scholar
  26. 26.
    Frink R, Rose J (1997) Cardiopulmonary resuscitation and direct cardiac injury: evidence of fractured coronary arteries and HIS bundle hemorrhage. J Invasive Cardiol 9:578–585PubMedGoogle Scholar
  27. 27.
    Cataneo AJM, Cataneo DC, de Oliveira FH, Arruda KA, Dib El R, de Oliveira Carvalho PE (1996) In: Cataneo AJM (ed) Surgical versus nonsurgical interventions for flail chest. John Wiley & Sons, Ltd, Chichester, pp 1–39.  https://doi.org/10.1002/14651858.CD009919.pub2 CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of WashingtonSeattleUSA
  2. 2.University and Polytechnic Hospital La FeValenciaSpain
  3. 3.Mater Misericordiae HospitalDublinIreland

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