Abstract 267: Injuries Associated With Mechanical Chest Compressions in Patients With Out-Of-Hospital Cardiac Arrest: A Comparison of LUCAS 2 and LUCAS 2 Active Decompression

Abstract

Background: Skeletal injuries (rib or sternum fractures) are common complications after cardiopulmonary resuscitation (CPR). Visceral injuries are also reported. During manual chest compressions, incidence of rib fractures is reported to be 13-97% and sternal fractures 1-43%. Studies on active compression decompression (AD) devices report incidence on rib fractures ranging from 4-87% and sternal fractures 0-93%. The aim of the present study is to describe and compare injury patterns caused by two mechanical, piston-based chest compression devices; LUCAS 2 and LUCAS 2AD in patients with out-of-hospital cardiac arrest. Method: In the randomized clinical trial comparing standard LUCAS 2 with LUCAS 2AD, patients who died were eligible for medical or forensic autopsy. The pathologists described injury pattern in each patient focusing on CPR-related injuries, but was blinded for the device used. We used Pearson X 2 test with an alpha level of 0.05 to evaluate our findings. Results: Of the 221 patients included between April 2015 and April 2017, 204 patients died of whom 115 were autopsied, LUCAS 2 n=62 and LUCAS 2 AD n=53. Median age was 63 (range: 19-91) and men represented 70%. CPR related rib fractures occurred in 70%, and sternal fractures in 45% of all patients. When comparing LUCAS 2 to LUCAS 2AD we found no difference in incidence of rib fractures (69% vs. 70%; p-value: 0.9) or in sternal fractures (44% vs. 47%; p-value: 0.7). Most frequent non-skeletal complication was bleeding in pleura (25), pericardium (13), mediastinum (7), abdomen (5), and ventricle (3). Many patients had bleedings reported from more than one location, but the amount of blood was mostly small and considered to not contribute to the cause of death. A total of 10 patients had injuries on internal organs such as lungs (6), liver (2), spleen (1), and diaphragm (1). Conclusion: Comparing LUCAS 2 with LUCAS 2AD we found no difference in rib- or sternal fractures. CPR related injuries on internal organs were rare. We conclude that LUCAS 2AD do not cause more skeletal or non-skeletal injuries compared to LUCAS 2.