Petrovich Polina, Berve Per Olav, Barth-Heyerdahl Roald Borghild, Wahl Kongsgård Håvard, Stray-Pedersen Arne, Kramer-Johansen Jo, Wik Lars
Norwegian National Advisory Unit on Prehospital Emergency Medicine, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
Resusc Plus. 2023 Jan 31;13:100362. doi: 10.1016/j.resplu.2023.100362. eCollection 2023 Mar.
Both skeletal and visceral injuries are reported after cardiopulmonary resuscitation (CPR). This subgroup analysis of a randomized clinical study describes/compares autopsy documented injury patterns caused by two mechanical, piston-based chest compression devices: standard LUCAS® 2 (control) and LUCAS® 2 with active decompression (AD, intervention) in non-survivors with out-of-hospital cardiac arrest (CA).
We compared injuries documented by autopsies (medical/forensic) after control and intervention CPR based on written relatives consent to use patients' data. The pathologists were blinded for the device used. The cause of CA and injuries reported were based on a prespecified study autopsy template. We used Pearson's chi-squared test and logistic regression analysis with an alpha level of 0.05.
221 patients were included in the main study (April 2015-April 2017) and 207 did not survive. Of these, 114 (55%, 64 control and 50 intervention) underwent medical ( = 73) or forensic ( = 41) autopsy. The cause of CA was cardiac 53%, respiratory 17%, overdose/intoxication 14%, ruptured aorta 10%, neurological 1%, and other 5%. There were no differences between control and intervention in the incidence of rib fractures (67% vs 72%; -value = 0.58), or sternal fractures (44% vs 48%; -value = 0.65), respectively. The most frequent non-skeletal complication was bleeding (26% of all patients) and intrathoracic was the most common location. Ten of the 114 patients had internal organ injuries, where lungs were most affected.
In non-survivors of OHCA patients, the most frequent cause of cardiac arrest was cardiogenic. Skeletal and non-skeletal fractures/injuries were found in both control and intervention groups. Bleeding was the most common non-skeletal complication. Internal organ injuries were rare.
心肺复苏（CPR）后既有骨骼损伤也有内脏损伤的报道。这项随机临床研究的亚组分析描述/比较了两种基于活塞的机械胸外按压装置导致的尸检记录损伤模式：标准LUCAS® 2（对照组）和具有主动减压功能的LUCAS® 2（AD，干预组），研究对象为院外心脏骤停（CA）的非存活者。
在获得亲属书面同意使用患者数据后，我们比较了对照组和干预组CPR后尸检（医学/法医）记录的损伤情况。病理学家对所使用的装置不知情。CA的病因和报告的损伤情况基于预先指定的研究尸检模板。我们使用Pearson卡方检验和逻辑回归分析，α水平为0.05。
221例患者纳入主要研究（2015年4月至2017年4月），207例未存活。其中，114例（55%，64例对照组和50例干预组）接受了医学（n = 73）或法医（n = 41）尸检。CA的病因是心脏原因占53%，呼吸原因占17%，药物过量/中毒占14%，主动脉破裂占10%，神经原因占1%，其他占5%。对照组和干预组肋骨骨折发生率（67%对72%；P值 = 0.58）或胸骨骨折发生率（44%对48%；P值 = 0.65）无差异。最常见的非骨骼并发症是出血（占所有患者的26%），胸腔内是最常见的部位。114例患者中有10例出现内脏损伤，其中肺部受影响最严重。
在院外心脏骤停患者的非存活者中，心脏骤停最常见的原因是心源性的。对照组和干预组均发现了骨骼和非骨骼骨折/损伤。出血是最常见的非骨骼并发症。内脏损伤很少见。
