Parenchymal lung injuries related to standard cardiopulmonary resuscitation

Cha, Kyoung‐Chul; Kim, Yongwon; Kim, Hyung Il; Kim, Oh Hyun; Sung, Yong; Lee, Kang Hyun; Hwang, Sung Oh

doi:10.1016/j.ajem.2016.10.036

Cited by 26 publications

(21 citation statements)

References 25 publications

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“…However, it may be common due to the overlap between the pathophysiology of ARDS and PCAS. Lung contusion, ischemia, and exposure to high-dose oxygen during CPR and the following reperfusion after CA, a profound systemic inflammatory response, ventilator-associated injuries, secondary infections, and systemic immune reactions could contribute to the development of ARDS [17,18]. These risk factors also existed in our study population and supported the prior findings that ARDS was a common problem for survivors of cardiac arrest [see Additional file, Table S2].…”

Section: Discussionsupporting

confidence: 86%

Impact of Lung Compliance on Neurological Outcome in Patients with Acute Respiratory Distress Syndrome Following Out-of-Hospital Cardiac Arrest

Kim

et al. 2020

JCM

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(1) Background: Acute respiratory distress syndrome (ARDS) following cardiac arrest is common and associated with in-hospital mortality. We aim to investigate whether lung compliance during targeted temperature management is associated with neurological outcome in patients with ARDS after out-of-hospital cardiac arrest (OHCA). (2) Methods: This observational study is conducted in the emergency intensive care unit from January 2011 to April 2019 using data from a prospective patient registry. Adult patients (age ≥18 years) who survived non-traumatic OHCA and subsequently developed ARDS based on the Berlin definition are included. Mechanical ventilator parameters such as plateau pressure, tidal volume, minute ventilation, positive end expiratory pressure, and compliance are recorded for 7 days or until death, and categorized as maximum, median, and minimum. The primary outcome is a favorable neurological outcome defined as a Cerebral Performance Category score of 1 or 2 at hospital discharge. (3) Results: Regarding 246 OHCA survivors, 119 (48.4%) patients developed ARDS. A favorable neurologic outcome was observed in 23 (19.3%). Patients with a favorable outcome have a significantly higher lung compliance (38.6 mL/cm H2O versus 27.5 mL/cm H2O), lower inspiratory pressure (12.0 cm H2O versus 16.0 cm H2O), and lower plateau pressure (17.0 cm H2O versus 21.0 cm H2O) than those with a poor neurologic outcome (all p < 0.01). Concerning time-dependent cox regression models, all maximum (adjusted hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.02–1.09), minimum (HR 1.08, 95% CI 1.03–1.13), and median (HR 1.06, 95% CI 1.02–1.09) compliances are independently associated with a good neurologic outcome. Maximum compliance, >32.5 mL/cm H2O at day 1, has the highest area under the receiver operating characteristic curve (0.745) with a positive predictive value of 90.4%. (4) Conclusions: Lung compliance may be an early predictor of intact neurologic survival in patients with ARDS following cardiac arrest.

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Section: Discussionsupporting

confidence: 86%

Impact of Lung Compliance on Neurological Outcome in Patients with Acute Respiratory Distress Syndrome Following Out-of-Hospital Cardiac Arrest

Kim

et al. 2020

JCM

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“…Based on our findings and previous data, we speculate that dogs experienced lung injury after ROSC in addition to heart failure. Lung injury often occurs after CPR, and the main pathological features are pulmonary hemorrhage, pulmonary edema, and atelectasis (27,28). Bacterial infection and inappropriate ventilation parameters, such as tidal volume and high positive end-expiratory pressure, may worsen lung injury after ROSC.…”

Section: Discussionmentioning

confidence: 99%

Enhanced external counterpulsation improves cardiac function in Beagles after cardiopulmonary resuscitation

Xiong

Zhang

et al. 2020

Braz J Med Biol Res

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The aim of this study was to investigate the influence of enhanced external counterpulsation (EECP) on the cardiac function of beagle dogs after prolonged ventricular fibrillation. Twenty-four adult male beagles were randomly divided into control and EECP groups. Ventricular fibrillation was induced in the animals for 12 min, followed by 2 min of cardiopulmonary resuscitation. They then received EECP therapy for 4 h (EECP group) or not (control group). The hemodynamics was monitored using the PiCCO2 system. Blood gas and hemorheology were assessed at baseline and at 1, 2, and 4 h after return of spontaneous circulation (ROSC). The myocardial blood flow (MBF) was quantified by 18 F-flurpiridaz PET myocardial perfusion imaging at baseline and 4 h after ROSC. Survival time of the animals was recorded within 24 h. Ventricular fibrillation was successfully induced in all animals, and they achieved ROSC after cardiopulmonary resuscitation. Survival time of the control group was shorter than that of the EECP group [median of 8 h (min 8 h, max 21 h) vs median of 24 h (min 16 h, max 24 h) (Kaplan Meyer plot analysis, P=0.0152). EECP improved blood gas analysis findings and increased the coronary perfusion pressure and MBF value. EECP also improved the cardiac function of Beagles after ROSC in multiple aspects, significantly increased blood flow velocity, and decreased plasma viscosity, erythrocyte aggregation index, and hematocrit levels. EECP improved the hemodynamics of beagle dogs and increased MBF, subsequently improving cardiac function and ultimately improving the survival time of animals after ROSC.

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“…Rib fractures are one of the most common complications during CPR (8). Rib fractures may lead to serious complications, such as pneumothorax, hemothorax, lung contusion, major vascular injuries, and flail chest (8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

CPR-related thoracic injuries: comparison of CPR guidelines between 2010 and 2015

Yusufoglu¹,

Erdoğan²,

Tayfur³

et al. 2018

Turk J Med Sci

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Background/aim: This study aimed to evaluate traumatic thorax complications in post-CPR patients and to investigate whether or not there has been a decrease in these complications since the adoption of current chest compression recommendations. Materials and methods: Post-CPR patients with return of spontaneous circulation (ROSC) were admitted between January 2014 and January 2016 were analyzed retrospectively. Patients admitted to the ED in 2014 were resuscitated according to 2010 AHA CPR guidelines, while those admitted to the ED in 2015 were resuscitated according to current ERC CPR guidelines. Results: The study population comprised 48 male and 35 female patients. Of the 2010 AHA guideline patients, 39.21% experienced pulmonary contusion, while 54.83% of 2015 ERC guideline patients had pulmonary contusion. It was found that 11.76% of 2010 AHA guideline patients and 3.22% of 2015 ERC guideline patients had pneumothorax, while 9.8% of 2010 AHA guideline patients and 12.9% of 2015 ERC guideline patients experienced hemothorax. Incidence rates of lung contusion, pneumothorax, and hemothorax were higher in patients with rib fractures. Conclusion: In this study, traumatic thoracic complications were investigated in patients with ROSC after CPR. The incidence of CRP-related injuries did not decrease on application of the new 2015 ERC CPR guideline recommendations. The most common injury in this study was rib fracture, followed by sternal fracture, lung contusion, hemothorax, and pneumothorax. Statistically, rib fracture had a positive relationship with lung contusion, hemothorax, and pneumothorax.

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Parenchymal lung injuries related to standard cardiopulmonary resuscitation

Cited by 26 publications

References 25 publications

Impact of Lung Compliance on Neurological Outcome in Patients with Acute Respiratory Distress Syndrome Following Out-of-Hospital Cardiac Arrest

Impact of Lung Compliance on Neurological Outcome in Patients with Acute Respiratory Distress Syndrome Following Out-of-Hospital Cardiac Arrest

Enhanced external counterpulsation improves cardiac function in Beagles after cardiopulmonary resuscitation

CPR-related thoracic injuries: comparison of CPR guidelines between 2010 and 2015

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