Ondruschka Benjamin, Baier Christina, Bayer Ronny, Hammer Niels, Dreßler Jan, Bernhard Michael
Institute of Legal Medicine, University of Leipzig, Leipzig, Germany.
Department of Anatomy, University of Otago, Dunedin, New Zealand.
Forensic Sci Med Pathol. 2018 Dec;14(4):515-525. doi: 10.1007/s12024-018-0024-5. Epub 2018 Sep 10.
The aim of this autopsy study was to investigate chest-compression associated injuries to the trunk in out-of-hospital and in-hospital non-traumatic cardiac arrest patients treated with automated external chest compression devices (ACCD; all with LUCAS II devices) versus exclusive manual chest compressions (mCC). In this retrospective single-center study, all forensic autopsies between 2011 and 2017 were included. Injuries following cardiopulmonary resuscitation (CPR) in patients treated with mCC or ACCD were investigated and statistically compared using a bivariate logistic regression. In the seven-year period with 4433 autopsies, 614 were analyzed following CPR (mCC vs. ACCD: n = 501 vs. n = 113). The presence of any type of trunk injury was correlated with longer resuscitation intervals (30 ± 15 vs. 44 ± 25 min, p < 0.05). In comparison with mCC, treatment with ACCD led to more frequent skin emphysema (5 vs 0%, p = 0.012), pneumothorax (6 vs. 1%, p = 0.008), lung lesions (19 vs. 4%, p = 0.008), hemopericardium (3 vs 1%, p = 0.025) and liver lesions (10 vs. 1%, p = 0.001), all irrespective of confounding aspects. Higher age and longer CPR durations statistically influenced frequency of sternal and rib fractures (p < 0.001). The mean number of fractured ribs did not vary significantly between the groups (6 ± 3 vs. 7 ± 2, p = 0.09). In this cohort with unsuccessful CPR, chest compression-related injuries were more frequent following ACCD application than in the mCC group, but with only minutely increased odds ratios. The severity of injuries did not differ between the groups, and no iatrogenic injury was declared by the forensic pathologist as being fatal. In the clinical routine after successful return of spontaneous circulation a computed tomography scan for CPR-associated injuries is recommended as soon as possible.
本尸检研究的目的是调查院外和院内非创伤性心脏骤停患者使用自动体外胸部按压设备（ACCD；均为LUCAS II设备）与单纯手动胸部按压（mCC）相比，胸部按压相关的躯干损伤情况。在这项回顾性单中心研究中，纳入了2011年至2017年间所有的法医尸检病例。对接受mCC或ACCD治疗的患者心肺复苏（CPR）后的损伤情况进行调查，并使用二元逻辑回归进行统计学比较。在进行4433例尸检的七年期间，对614例CPR后的病例进行了分析（mCC组与ACCD组：n = 501 vs. n = 113）。任何类型的躯干损伤的出现都与更长的复苏间隔相关（30±15分钟 vs. 44±25分钟，p < 0.05）。与mCC相比，ACCD治疗导致更频繁出现皮下气肿（5% vs 0%，p = 0.012）、气胸（6% vs. 1%，p = 0.008）、肺部损伤（19% vs. 4%，p = 0.008）、心包积血（3% vs 1%，p = 0.025）和肝脏损伤（10% vs. 1%，p = 0.001），所有这些均与混杂因素无关。较高的年龄和较长的CPR持续时间在统计学上影响胸骨和肋骨骨折的发生率（p < 0.001）。两组之间肋骨骨折的平均数量没有显著差异（6±3 vs. 7±2，p = 0.09）。在这个CPR未成功的队列中，应用ACCD后胸部按压相关损伤比mCC组更频繁，但优势比仅略有增加。两组之间损伤的严重程度没有差异，法医病理学家也未宣布有任何医源性损伤是致命的。在自主循环成功恢复后的临床常规操作中，建议尽快进行CT扫描以检查CPR相关损伤。
