Using transpulmonary thermodilution leads successful fluid resuscitation in early phase of septic shock

Abstract

Purpose of the study: The reported incidence of rib and sternum fractures after unsuccessful cardiopulmonary resuscitation by manual chest compressions (manual CPR) in the twentieth century varied greatly, and it was generally considered that at least 1/3 of resuscitated patients sustained rib fractures and at least 1/5 sternum fractures. However, recent studies indicate amuch higher incidence of such injuries. Increasing use of the LUCASTM device (mechanical CPR) raises the question of whether it has any adverse effects. Our goal was to compare the incidence and number of rib and sternum fractures after manual and mechanical CPR. Materials and methods: This retrospective autopsy study included 946 patients (802 manual CPR and 144 mechanical CPR) resuscitated in the period 2011–2014, i.e., when Guidelines 2010 were applied. Results: At least one rib fracture was found in 86.9% of the patients resuscitated manually and in 88.9% of those resuscitated mechanically (p=0.512). Sternum fractures were found in 64.2% of the patients resuscitated manually and in 72.9% of those resuscitated mechanically (p=0.043). Either rib or sternum fractures or both were found in 88.8% of the patients in the manual CPR group and 93.1% of the patients in the mechanical CPR group (p=0.854). The average number of rib and sternum fractures per injured patient was 12.04 in the manual CPR group and 11.88 in the mechanical CPR group. Conclusion: In the studied population, mechanical CPR caused approximately 4% more rib and/or sternum fractures than manual CPR. However, the average number of fractures per injured patient was slightly lower in the mechanical CPR group.1,2