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Chest wall injuries due to cardiopulmonary resuscitation and the effect on in-hospital outcomes in survivors of out-of-hospital cardiac arrest.
- Source :
-
The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2021 Dec 01; Vol. 91 (6), pp. 966-975. - Publication Year :
- 2021
-
Abstract
- Background: This study aimed to assess the prevalence of chest wall injuries due to cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA) and to compare in-hospital outcomes in patients with versus without chest wall injuries.<br />Methods: A retrospective cohort study of all intensive care unit (ICU)-admitted patients who underwent cardiopulmonary resuscitation for OHCA between January 1, 2007, and December 2019 was performed. The primary outcome was the occurrence of chest wall injuries, as diagnosed on chest computed tomography. Chest wall injury characteristics such as rib fracture location, type, and dislocation were collected. Secondary outcomes were in-hospital outcomes and subgroup analysis of patients with good neurological recovery to identify those who could possibly benefit from the surgical stabilization of rib fractures.<br />Results: Three hundred forty-four patients were included, of which 291 (85%) sustained chest wall injury. Patients with chest wall injury had a median of 8 fractured ribs (P25-P75, 4-10 ribs), which were most often undisplaced (on chest computed tomography) (n = 1,574 [72.1%]), simple (n = 1,948 [89.2%]), and anterior (n = 1,785 [77.6%]) rib fractures of ribs 2 to 7. Eight patients (2.3%) had a flail segment, and 136 patients (39.5%) had an anterior flail segment. Patients with chest wall injury had fewer ventilator-free days (0 days [P25-P75, 0-16 days] vs. 13 days [P25-P75, 2-22 days]; p = 0.006) and a higher mortality rate (n = 102 [54.0%] vs. n = 8 [22.2%]; p < 0.001) than those without chest wall injury. For the subgroup of patients with good neurological recovery, the presence of six or more rib fractures or a single displaced rib fracture was associated with longer hospital and ICU length of stay, respectively.<br />Conclusion: Cardiopulmonary resuscitation-related chest wall injuries in survivors of OHCA and especially rib fractures are common. Patients with chest wall injury had fewer ventilator-free days and a higher mortality rate. Patients with good neurological recovery might represent a subgroup of patients who could benefit from surgical stabilization of rib fractures.<br />Level of Evidence: Therapeutic, level IV; Epidemiological, Level IV.<br /> (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Cardiopulmonary Resuscitation methods
Cohort Studies
Female
Fracture Fixation methods
Humans
Intensive Care Units statistics & numerical data
Length of Stay statistics & numerical data
Male
Middle Aged
Mortality
Netherlands epidemiology
Survivors statistics & numerical data
Trauma Severity Indices
Cardiopulmonary Resuscitation adverse effects
Flail Chest diagnosis
Flail Chest etiology
Out-of-Hospital Cardiac Arrest mortality
Out-of-Hospital Cardiac Arrest therapy
Rib Fractures diagnosis
Rib Fractures etiology
Thoracic Injuries diagnosis
Thoracic Injuries etiology
Subjects
Details
- Language :
- English
- ISSN :
- 2163-0763
- Volume :
- 91
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The journal of trauma and acute care surgery
- Publication Type :
- Academic Journal
- Accession number :
- 34407009
- Full Text :
- https://doi.org/10.1097/TA.0000000000003379