Risk factors for cardiopulmonary resuscitation-related injuries sustained during out-of-hospital cardiac arrests

Acta Anaesthesiol Scand. 2018 Oct;62(9):1290-1296. doi: 10.1111/aas.13155. Epub 2018 May 24.


Background: We aimed to determine the incidence of and associated risk factors for cardiopulmonary resuscitation (CPR)-related injuries in non-survivors of out-of-hospital cardiac arrests (OHCAs) in an emergency medical service (EMS) system in which all CPR procedures are performed on scene and patients are not routinely transported to the hospital with ongoing CPR.

Material and methods: We conducted this prospective observational study between 1 June 2013, and 31 May 2014. Data were collected from EMS datasheets and forensic autopsy records. The exclusion criteria were OHCAs due to trauma in the thoracic or abdominal area. EMS adhered to the European Resuscitation Council Resuscitation Guidelines (2010) during the resuscitation attempts.

Results: Emergency medical service provided CPR in 280 attended OHCAs with 207 cases terminated on scene. A total of 149 patients underwent a forensic autopsy and 47% had a CPR-related injury. The most common injuries were multiple rib fractures (43%), with 22% of patients having more than eight fractured ribs. Abdominal visceral injuries or injuries related to airway management were rare. The injuries were associated with older age, male gender, initial shockable rhythm and public location of the cardiac arrest (P < .05 respectively). In the multivariable regression analysis, older age, male gender, and public location were independent predictors for injuries. There were no differences in the durations of the CPR attempt between the injured and non-injured groups.

Conclusion: Older age, male gender, and public location were independently associated with CPR-related injuries. The duration of the resuscitation attempts did not affect the incident of injuries.

Trial registration: ClinicalTrials.gov NCT00951704.

Keywords: CPR-related injuries; autopsy study; cardiac arrest; cardiopulmonary resuscitation; complication; out-of-hospital cardiac arrest; rib fractures; risk factors; thoracic injuries.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Injuries / epidemiology
  • Abdominal Injuries / etiology
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Autopsy
  • Cardiopulmonary Resuscitation / adverse effects*
  • Emergency Medical Services
  • Female
  • Finland / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / complications*
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Prospective Studies
  • Rib Fractures / epidemiology
  • Rib Fractures / etiology
  • Risk Factors
  • Sex Factors
  • Wounds and Injuries / epidemiology*
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT00951704