EVALUATION OF THORACIC INJURIES WITH THORACIC CT IN PATIENTS WITH RETURN OF SPONTANEOUS CIRCULATION AFTER CARDIOPULMONARY RESUSCITATION

Abstract

Objective: In this study, we aimed to identify post-CPR (cardiopulmonary resuscitation) injuries.

Material and Methods: This study was conducted retrospectively in 47 patients who had non-traumatic arrest and return of spontaneous circulation after CPR. Age, gender, CPR duration, findings of thoracic CT after CPR and mortality data of patients were evaluated.

Results: The median age of the patients in our study was 73 years (IQR: 18) and 59.6% of the patients were female. The age and duration of CPR were significantly higher in patients with identified CPR-related injuries (p<0.05). There was no correlation between CPR-related injury and gender and death (p>0.05). Rib fractures were found in 48.9%, lung contusion in 23.4%, hemothorax in 17%, pneumothorax in 10.6%, pneumomediastinum in 4.3% and clavicle fracture in 2.1% of all patients.

Conclusion: Injuries due to chest trauma often develop in cases that respond to CPR. Therefore, clinicians who follow-up the patient should keep in mind that injuries may occur after CPR and determine treatment protocols aimed for these complications in terms of post cardiac arrest.

Keywords

• Cardiopulmonary resuscitation,computed tomography,thoracic injuries

Kardiyopulmoner Resüsitasyon Sonrası Dolaşımın Sağlandığı Hastalarda Gelişen Toraks Yaralanmaların Toraks BT ile Değerlendirilmesi

Abstract

Amaç: Bu çalışmada kardiopulmoner resusitasyon (CPR) sonrası gelişen yaralanmaları tespit etmeyi amaçladık.

Gereç ve Yöntemler: Çalışma, nontravmatik sebeplere bağlı arrest olan ve CPR sonucu spontan dolaşımın sağlandığı 47 hastada retrospektif olarak yapıldı. Hastaların yaş, cinsiyet, CPR süresi, CPR sonrası toraks tomografisindeki bulgular ve mortalite durumları değerlendirildi.

Bulgular: Çalışmamızdaki hastaların yaş ortancası 73 (IQR: 18) yıl olup, hastaların %59.6’sı kadındı. CPR’a bağlı yaralanma saptanan hastaların yaş ve CPR süresi anlamlı olarak yüksekti (p<0.05). CPR’a bağlı yaralanma ile cinsiyet ve eksitus olma arasında ilişki saptanmadı (p>0.05). Hastaların %48.9’unda kosta fraktürü, %23.4’ünde akciğer kontüzyonu, %17’sinde hemotoraks, %10.6’sında pnömotoraks, %4.3’ünde pnömomediastinum ve %2.1’inde klavikula fraktürü saptandı.

Sonuç: CPR’a yanıt veren olgularda toraks travmasına bağlı yaralanmalar sıklıkla gelişmektedir. Bu nedenle hastayı takip eden klinisyenlerin CPR sonrası yaralanmalar oluşabileceğini akılda tutmaları ve kardiyak arrest sonrası bakımda bu komplikasyonlara yönelik tedavi protokollerini belirlemeleri gerekmektedir.

Keywords

• kardiopulmoner resusistasyon,bilgisayarlı tomografi,toraks yaralanmaları

References

1. 1. Cha KC, Kim YW, Kim HI, Kim OH, Cha YS, Kim H et al. Parenchymal lung injuries related to standard cardiopulmonary resuscitation. Am J Emerg Med. 2017;35(1):117-21.
2. 2. HIGHLIGHTS of the 2015 American Heart Association Guidelines Update for CPR and ECC. American Heart Association. Web site. Accessed date: 15 July 2019: https://eccguidelines.heart.org/wp content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf.
3. 3. Hellevuo H, Sainio M, Nevalainen R, Huhtala H, Olkkola KT, Tenhunen J et al. Deeper chest compression–more complications for cardiac arrest patients? Resuscitation. 2013;84(6):760-5.
4. 4. Rutty GN, Morgan B. Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered. Resuscitation. 2015;93:A1-A2.
5. 5. Miller AC, Rosati SF, Suffredini AF, Schrump DS. A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries. Resuscitation. 2014;85(6):724-31.
6. 6. Ram P, Menezes RG, Sirinvaravong N, Luis SA, Hussain SA, Madadin M et al. Breaking your heart-A review on CPR-related injuries. Am J Emerg Med. 2018;36(5):838-42.
7. 7. Kralj E. Error in the editorial entitled "Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered". Resuscitation. 2015;97:e9; discussion e11.
8. 8. Black CJ, Busuttil A, Robertson C. Chest wall injuries following cardiopulmonary resuscitation. Resuscitation. 2004;63(3):339-43.

9. 9. Baubin M, Sumann G, Rabl W, Eibl G, Wenzel V, Mair P. Increased frequency of thorax injuries with ACD-CPR. Resuscitation. 1999;41(1):33-8.
10. 10. Kashiwagi Y, Sasakawa T, Tampo A, Kawata D, Nishiura T, Kokita N et al. Computed tomography findings of complications resulting from cardiopulmonary resuscitation. Resuscitation. 2015;88:86-91.
11. 11. Seung M, Park Y. Comparison of complications secondary to cardiopulmonary resuscitation between out-of-hospital cardiac arrest and in-hospital cardiac arrest. Critical Care. 2015;19(1):P419.
12. 12. Cho JC, Seo YW, Kim G, Lee KW, Choi DH, Jang TC. Factors associated with skeletal chest ınjuries secondary to cardiopulmonary resuscitation of ın-hospital cardiac arrest patients. J Korean Soc Emerg Med. 2015;26(5):409-16.
13. 13. Kim MJ, Park YS, Kim SW, Yoon YS, Lee KR, Lim TH et al. Chest injury following cardiopulmonary resuscitation: a prospective computed tomography evaluation. Resuscitation. 2013;84(3):361-4.
14. 14. Kim EY, Yang HJ, Sung YM, Cho SH, Kim JH, Kim HS et al. Multidetector CT findings of skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation. 2011;82(10):1285-8.
15. 15. Rudinská LI, Hejna P, Ihnát P, Tomášková H, Smatanová M, Dvořáček I. Intra-thoracic injuries associated with cardiopulmonary resuscitation–Frequent and serious. Resuscitation. 2016;103:66-70.
16. 16. Choi SJ, Kim HS, Kim EY, Choi HY, Cho J, Yang HJ et al. Thoraco-abdominal CT examinations for evaluating cause of cardiac arrest and complications of chest compression in resuscitated patients. Emerg Radiol. 2014;21(5):485-90.
17. 17. Beom JH, You JS, Kim MJ, Seung MK, Park YS, Chung HS et al. Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study. Scand J Trauma Resusc Emerg Med. 2017;25(1):8.
18. 18. Juan YH, Saboo SS, Desai NS, Khandelwal K, Khandelwal A. Aortic intramural hematoma and hepatic artery pseudoaneurysm: unusual complication following resuscitation. Am J Emerg Med. 2014;32(1):107.e1-4.
19. 19. Spoormans I, Van Hoorenbeeck K, Balliu L, Jorens PG. Gastric perforation after cardiopulmonary resuscitation: review of the literature. Resuscitation. 2010;81(3):272-80.