CPR related thoracic injury: a comparison of CPR guidelines between 2005 and 2010

The objective of this study was to investigate the incidence and characteristics of thoracic injuries associated with cardiopulmonary resuscitation (CPR) performed under the 2005 and the 2010 guidelines.

We evaluated patients who had an out-of-hospital cardiac arrest in 2010 (2005 group) and 2012 (2010 group). We analyzed the incidence and characteristics of rib fractures and pneumothoraces received during CPR as determined by medical records and image studies.

Two hundred and ninety-two patients in the 2005 group and 243 in the 2010 group were enrolled. The number of patients with rib fractures was greater in the 2010 group than in the 2005 group (123 [42.1%] versus 167 [68.7%], P < 0.001), and the number of pneumothorax patients with rib fractures was also higher (8 [2.7%] versus 21 [8.6%], P = 0.004). Of the 21 patients, four had a tension pneumothorax. The anterior-posterior diameter of the chest (APD) was smaller in patients with a pneumothorax and rib fractures than those without the injuries (166.0 mm [standard deviation 22.8] versus 176.2 mm [standard deviation 21.0], P = 0.04), and the APD for patients of Japanese descent was smaller than that of patients of European descent by more than 50 mm.

The number of rib fractures and pneumothoraces received during CPR increased significantly under the 2010 guidelines when compared with the 2005 guidelines. As the APD for patients of Japanese descent is smaller than that of patients of European descent, Japanese medical facilities need to be prepared for possible fatal adverse events associated with CPR under the current international guidelines.