Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered

Resuscitation. 2015 Aug:93:136-41. doi: 10.1016/j.resuscitation.2015.02.034. Epub 2015 Mar 12.


Aim of the study: This study aimed to establish the incidence, number and location of CPR-related skeletal chest injuries (SCI) and to investigate the influence of age, gender, changes in resuscitation guidelines and technique of resuscitation.

Methods: We analysed SCI in 2148 patients who had undergone resuscitation for non-traumatic cardiac arrest, as shown by autopsies performed at the Institute of Forensic Medicine in Ljubljana in the period 2004-2013.

Results: External cardiac massage caused SCI in 86% of males and in 91% of females; sternum fractures occurred in 59% of males and 79% of females, rib fractures in 77% of males and 85% of females and sternocostal separations in 33% of males and 12% of females. The average number of all SCI per person was thus almost the same in males and females: 10.95 vs. 10.96. The percentage of patients injured and the number of SCI increased with age. Changes in resuscitation guidelines were also identified as a factor contributing to the incidence and number of SCI. No adverse effect of the use of LUCAS was found.

Conclusion: It is generally considered that at least 1/3 of resuscitated patients sustain rib fractures and at least 1/5 sustains sternum fractures. However, our study showed that these injuries are much more frequent and that increased compression rate and depth cause more SCI. Since in the period 2011-2013 accompanying severe injuries occurred in only 1.85% of cases, the resuscitation technique has not yet jeopardised patient's safety, but further close monitoring is needed.

Keywords: Age; Cardiopulmonary resuscitation; ERC guidelines; Gender; LUCAS; Skeletal chest injuries.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cardiopulmonary Resuscitation* / adverse effects
  • Cardiopulmonary Resuscitation* / methods
  • Diagnosis
  • Female
  • Heart Arrest / etiology
  • Heart Arrest / therapy*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Pressure / adverse effects*
  • Rib Fractures* / diagnosis
  • Rib Fractures* / epidemiology
  • Rib Fractures* / etiology
  • Risk Factors
  • Slovenia / epidemiology
  • Sternum / injuries*
  • Thoracic Injuries* / diagnosis
  • Thoracic Injuries* / epidemiology
  • Thoracic Injuries* / etiology