Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers

Resuscitation. 1999 Dec;43(1):9-15. doi: 10.1016/s0300-9572(99)00110-0.


In a prospective study of 38 cadavers of patients older than 18 without previous chest injury or cardiopulmonary resuscitation (CPR), active compression-decompression (ACD) resuscitation manoeuvres were performed to determine possible factors influencing sternal and/or rib fractures. ACD was performed for 60 s, with compression and decompression forces being continuously recorded. A stepwise logistic regression analysis was applied. Factors analyzed were age, gender, use of a compression cushion beneath the piston of the ACD device (Ambu CardioPump), and maximal compression and decompression forces. After ACD, the cadavers were autopsied and thoracic injuries were assessed. There was a significant correlation between sternal fractures and gender (P = 0.008), and between rib fractures and age (P = 0.008). Women were found to have a higher risk for sternal fractures, whereas older patients had a higher risk for rib fractures. Maximal compression force was another factor in sternal and/or rib fracture (P = 0.048). Even though a significantly higher incidence of sternal fractures was observed when the compression cushion was used (P = 0.045), inclusion of this variable in the regression analysis only marginally improved the prediction for correct classification of sternal fractures. In conclusion, when well controlled ACD-CPR is performed in cadavers, age is the most important factor determining the incidence of rib fracture. Sternal fractures were more common in female cadavers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Cadaver
  • Cardiopulmonary Resuscitation / adverse effects
  • Cardiopulmonary Resuscitation / methods*
  • Female
  • Fractures, Bone / etiology
  • Humans
  • Logistic Models
  • Male
  • Rib Fractures / etiology
  • Sex Factors
  • Sternum / injuries
  • Thoracic Injuries / etiology*