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Frequency and influencing factors of cardiopulmonary resuscitation-related injuries during implementation of the American Heart Association 2010 Guidelines: a retrospective study based on autopsy and postmortem computed tomography

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Abstract

Aim

To determine the frequency of cardiopulmonary resuscitation (CPR)-related injuries and factors involved in their occurrence, data based on forensic autopsy and postmortem computed tomography (PMCT) during implementation of the 2010 American Heart Association Guidelines for CPR were studied.

Methods

We retrospectively evaluated data on adult patients with non-traumatic deaths who had undergone manual CPR and autopsy from January 2012 to December 2014. CPR-related injuries were analyzed on autopsy records and PMCT images and compared with results of previous studies.

Results

In total, 180 consecutive cases were analyzed. Rib fractures and sternal fractures were most frequent (overall frequency, 66.1 and 52.8%, respectively), followed by heart injuries (12.8%) and abdominal visceral injuries (2.2%). Urgently life-threatening injuries were rare (2.8%). Older age was an independent risk factor for rib fracture [adjusted odds ratio (AOR), 1.06; 95% confidence interval (CI), 1.04–1.08; p < 0.001], ≥ 3 rib fractures (AOR, 1.06; 95% CI, 1.02–1.09; p = 0.002), and sternal fracture (AOR, 1.03; 95% CI, 1.01–1.05; p < 0.001). Female sex was significantly associated with sternal fracture (AOR, 2.08; 95% CI, 1.02–4.25; p = 0.04). Chest compression only by laypersons was inversely associated with rib and sternal fractures. Body mass index and in-hospital cardiac arrest were not significantly associated with any complications. The frequency of thoracic skeletal injuries was similar to that in recent autopsy-based studies.

Conclusions

Implementation of the 2010 Guidelines had little impact on the frequency of CPR-related thoracic skeletal injuries or urgently life-threatening complications. Older age was the only independent factor related to thoracic skeletal injuries.

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Authors and Affiliations

  1. Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Rutsuko Yamaguchi, Yohsuke Makino, Fumiko Chiba, Suguru Torimitsu, Mari Hashimoto & Hirotaro Iwase

  2. Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan

    Rutsuko Yamaguchi, Yohsuke Makino, Fumiko Chiba, Suguru Torimitsu, Daisuke Yajima, Go Inokuchi, Ayumi Motomura, Mari Hashimoto, Yumi Hoshioka & Hirotaro Iwase

  3. Education and Research Center of Legal Medicine, Department of Forensic Radiology and Imaging, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba Prefecture, 260-8670, Japan

    Yohsuke Makino

  4. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Tomohiro Shinozaki

Authors
  1. Rutsuko Yamaguchi
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  2. Yohsuke Makino
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  3. Fumiko Chiba
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  4. Suguru Torimitsu
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  5. Daisuke Yajima
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  6. Go Inokuchi
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  7. Ayumi Motomura
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  8. Mari Hashimoto
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  9. Yumi Hoshioka
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  10. Tomohiro Shinozaki
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  11. Hirotaro Iwase
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Corresponding author

Correspondence to Rutsuko Yamaguchi.

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Yamaguchi, R., Makino, Y., Chiba, F. et al. Frequency and influencing factors of cardiopulmonary resuscitation-related injuries during implementation of the American Heart Association 2010 Guidelines: a retrospective study based on autopsy and postmortem computed tomography. Int J Legal Med 131, 1655–1663 (2017). https://doi.org/10.1007/s00414-017-1673-8

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  • DOI: https://doi.org/10.1007/s00414-017-1673-8

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