Unexpected collateral impact after out of hospital resuscitation using LUCAS system

Shahinian, Jasmin H.; Quitt, Jonas; Wiese, Mark; Eckstein, Friedrich S.; Reuthebuch, Oliver

doi:10.1186/s13019-017-0643-z

Cited by 4 publications

(7 citation statements)

References 9 publications

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“…Common injuries include fractures (rib, sternal), pneumothoraces, and visceral organ damage (liver, spleen, heart) [ 46 – 48 ]. Several case reports have purportedly linked mechanical device use with clinically important injuries, thereby driving concern that mechanical devices may increase risk of injury compared with manual CPR [ 49 – 51 ]. Whilst evidence from cohort studies has produced mixed results, interpretation of these studies is challenging as they are prone to selection bias and the quality of manual CPR delivered, as the comparator group, is generally not recorded [ 52 – 55 ].…”

Section: Introductionmentioning

confidence: 99%

Mechanical CPR: Who? When? How?

et al. 2018

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In cardiac arrest, high quality cardiopulmonary resuscitation (CPR) is a key determinant of patient survival. However, delivery of effective chest compressions is often inconsistent, subject to fatigue and practically challenging.Mechanical CPR devices provide an automated way to deliver high-quality CPR. However, large randomised controlled trials of the routine use of mechanical devices in the out-of-hospital setting have found no evidence of improved patient outcome in patients treated with mechanical CPR, compared with manual CPR. The limited data on use during in-hospital cardiac arrest provides preliminary data supporting use of mechanical devices, but this needs to be robustly tested in randomised controlled trials.In situations where high-quality manual chest compressions cannot be safely delivered, the use of a mechanical device may be a reasonable clinical approach. Examples of such situations include ambulance transportation, primary percutaneous coronary intervention, as a bridge to extracorporeal CPR and to facilitate uncontrolled organ donation after circulatory death.The precise time point during a cardiac arrest at which to deploy a mechanical device is uncertain, particularly in patients presenting in a shockable rhythm. The deployment process requires interruptions in chest compression, which may be harmful if the pause is prolonged. It is recommended that use of mechanical devices should occur only in systems where quality assurance mechanisms are in place to monitor and manage pauses associated with deployment.In summary, mechanical CPR devices may provide a useful adjunct to standard treatment in specific situations, but current evidence does not support their routine use.

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Section: Introductionmentioning

confidence: 99%

Mechanical CPR: Who? When? How?

et al. 2018

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“…Experience has been limited, thus far, to case reports and small case series. [16][17][18][19] In our review, the early outcomes seem favorable in carefully selected patients. The majority of injuries were defined as anterior flail chest and required bilateral rib fixation often with sternal fixation (Figs.…”

Section: Discussionmentioning

confidence: 77%

“…With benefits clearly appreciated for flail fracture patterns and multiple, displaced fractures in the trauma population, application of surgical stabilization of these injuries following CPR could be valuable. Experience has been limited, thus far, to case reports and small case series 16–19 . In our review, the early outcomes seem favorable in carefully selected patients.…”

Section: Discussionmentioning

confidence: 91%

Surgical stabilization of severe chest wall injury following cardiopulmonary resuscitation

DeVoe¹,

Abourezk²,

Goslin³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Cardiopulmonary resuscitation (CPR) contributes to significant chest wall injury similar to blunt trauma. With benefits realized for surgical stabilization of rib fractures (SSRFs) for flail injuries and severely displaced fractures following trauma, SSRF for chest wall injury following CPR could be advantageous, provided good functional and neurologic outlook. Experience is limited. We present a review of patients treated with SSRF at our institution following CPR. METHODS:A retrospective analysis of patients undergoing SSRF following CPR was performed between 2019 and 2020. Perioperative inpatient data were collected with outpatient follow-up as able. RESULTS:Five patients underwent SSRF over the course of the 2-year interval. All patients required invasive ventilation preoperatively or had impending respiratory. Mean age was 59 ± 12 years, with all patients being male. Inciting events for cardiac arrest included respiratory, ventricular tachycardia, ventricular fibrillation, pulseless electrical activity, and anaphylaxis. Time to operation was 6.6 ± 3 days. Four patients demonstrated anterior flail injury pattern with or without sternal fracture, with one patient having multiple severely displaced fractures. Surgical stabilization of rib fracture was performed appropriately to restore chest wall stability. Mean intensive care unit length of stay was 9.8 ± 6.4 days and overall hospital length of stay 24.6 ± 13.2 days. Median postoperative ventilation was 2 days (range, 1-15 days) with two patients developing pneumonia and one requiring tracheostomy. There were no mortalities at 30 days. One patient expired in hospice after a prolonged hospitalization. Disposition destination was variable. No hardware complications were noted on outpatient follow-up, and all surviving patients were home. CONCLUSION:Chest wall injuries are incurred frequently following CPR. Surgical stabilization of these injuries can be considered to promote ventilator liberation and rehabilitation. Careful patient selection is paramount, with surgery offered to those with reversible causes of arrest and good functional and neurologic outcome. Experience is early, with further investigation needed.

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“…To our knowledge, there is only one previous case report that describes concomitant cardiac operation and stabilization of chest wall. 4 In the case reported by Shahinian and colleagues the fractures were sustained during resuscitation using LUCAS system, and it only involved CABG.…”

Section: Case Presentationmentioning

confidence: 99%

Concomitant cardiac surgery and fixation of bilateral rib fractures sustained during cardiopulmonary resuscitation

Comanici

Farmidi

Bhudia

et al. 2022

Journal of Cardiac Surgery

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Background: Chest compressions during cardiopulmonary resuscitation (CPR) may cause sternal or rib fractures and chest wall instability. This can complicate medical management and significantly impair respiratory function. Surgical management of flail chest is technically demanding, and it becomes even more challenging if the patient requires a concomitant cardiac procedure.Case Presentation: A 78-year-old male suffered a cardiac arrest and sustained sternal and bilateral rib fractures during a successful CPR. He underwent a concomitant coronary artery bypass grafting and aortic valve replacement combined with stabilization of the chest wall. We discuss the possibility of fixation of bilateral rib fractures and its role in postoperative recovery after cardiac surgery.Conclusions: Chest wall stabilization for an already fragile patient, with impaired respiratory system performance, could help improve overall outcomes, pulmonary function, weaning from mechanical ventilation, and rehabilitation. It may be used together with a cardiac procedure for a life-threatening cardiac pathology.

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Unexpected collateral impact after out of hospital resuscitation using LUCAS system

Cited by 4 publications

References 9 publications

Mechanical CPR: Who? When? How?

Mechanical CPR: Who? When? How?

Surgical stabilization of severe chest wall injury following cardiopulmonary resuscitation

Concomitant cardiac surgery and fixation of bilateral rib fractures sustained during cardiopulmonary resuscitation

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