Abstract 239: The Relationship Between Duration of Chest Compression and Traumatic Thoracic Injuries in Out-of-hospital Cardiac Arrest Patients

Abstract

Background: Recent guidelines emphasized that high-quality chest compression is essential for improving the survival in out-of-hospital cardiac arrest (OHCA) patients. However, it may lead to critical traumatic injuries. Method: Between June. 2018 to Mar. 2019, we collected Utstein-style data on 130 consecutive adult patients with non-traumatic OHCA who were transferred to our hospital without return of spontaneous circulation (ROSC). Patients with aortic dissection and aortic aneurysmal rupture were excluded. Full-body CT scan was performed in all patients and chest compression-induced thoracic injuries were defined as rib fracture, sternum fracture, hemopneumothorax, mediastinal emphysema or intrathoracic hematoma. We identified the possible predictors for thoracic injuries and evaluated the relation between traumatic thoracic injuries and 30-day survival. Results: Patients with thoracic injuries were 105 (81%). The duration of chest compression in patients with thoracic injuries was significantly longer than that in patients without thoracic injuries (30 vs 38min, p<0.01). ROC analysis identified a duration of chest compression of 35 minutes as the optimal cutoff point for predicting thoracic injuries (sensitivity 0.59, specificity 0.83, area under the curve 0.71). Multivariate analysis revealed that age and duration of chest compression were predictors of thoracic injuries (OR 1.05, 1.07, p≦0.01, respectively). The rates of 30-day survival in patients with thoracic injuries was significantly lower than those without thoracic injuries (1 % vs 16 %, p<0.01). Conclusion: The duration of chest compression was one of the independent predictors for thoracic injuries in non-traumatic OHCA patients. Prolonger duration of chest compression are potential candidates for CT scan to diagnose thoracic injuries.