Chest
Volume 92, Issue 2, August 1987, Pages 287-291
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Complications of Cardiac Resuscitation

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In a prospective study of the complications of cardiac resuscitation, 705 cases were autopsied to identify the cause of death and the pathologic findings attributable to cardiac resuscitation. Thoracic complications were observed in 42.7 percent of the cases. A total of 31.6 percent had rib fractures, 21.1 percent had sternal fractures, and 18.3 percent were reported as having anterior mediastinal hemorrhage; 20.4 percent of the cases had an upper airway complication. Abdominal visceral complications were noted in 30.8 percent of the cases, and pulmonary complications occurred in 13 percent of the resuscitation population. Life-threatening complications, such as heart and great vessel injuries, occurred in less than. 5 percent of the cases.

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METHODS

Paramedics from fire-rescue departments servicing Dade County, Florida, identified individuals undergoing prehospital resuscitation from Jan 1, 1977 through Aug 31, 1979. Fire department casualty reports and Medical Examiner investigative reports were reviewed daily and served as secondary sources of case identification. To qualify for inclusion, the following criteria had to be met; (1) trained personnel determined that the patient was in cardiac arrest; (2) the patient was responded to by

RESULTS

Of the 2,187 consecutive prehospital cardiac arrest patients identified during the study period, 705, or 32.2 percent, were autopsied by the Office of the Medical Examiner. These victims were predominantly men (70.7 percent) with a mean age of 45.6 years (Table 2). The arrest was often due to nonnatural causes (46.5 percent), either traumatic or nontraumatic (eg, vehicular accident, drowning, overdose), and CPR was given for more than 20 minutes (77.5 percent). The mechanical cardiocompressor

DISCUSSION

To put these findings into perspective, it is important to note that prehospital CPR, as currently practiced, includes external chest compressions and ventilation, as well as definitive emergency maneuvers (eg, defibrillation, drug administration), each of which has a strong potential for injurious consequences. Specifically, external chest compressions have been observed to result in fractures of the rib, cartilage, sternum, and cervical spine. Additionally, cardiac massage causes soft tissue

ACKNOWLEDGMENT

The authors gratefully acknowledge the County, and the cities of Miami, Coral Gables, Hialeah, and Miami Beach.

REFERENCES (14)

  • WB Kouwenhoven et al.

    Closed-chest cardiac massage

    JAMA

    (1960)
  • DA Enarson

    Complications of cardiopulmonary resuscitation

    Heart and Lung

    (1976)
  • EL Nagel et al.

    Complications of CPR

    Crit Care Med

    (1981)
  • RH Patterson et al.

    Complications of external cardiac resuscitation: a retrospective review and survey of the literature

    Med Ann DC

    (1974)
  • J Powner et al.

    Cardiopulmonary resuscitation-related injuries

    Crit Care Med

    (1984)
  • JW Garvey et al.

    Pulmonary bone marrow emboli in patients receiving external cardiac massage

    JAMA

    (1964)
  • JR Baringer et al.

    External cardiac massage

    N Engl J Med

    (1961)
There are more references available in the full text version of this article.

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This research was supported by the National Center for Health Services Research grant No. 02567.

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