Left rib fractures during cardiopulmonary resuscitation are associated with hemodynamic variations in a pig model of cardiac arrest

Deborah Jaeger; Rajat Kalra; Pierre Sebastian; Christopher Gaisendrees; Marinos Kosmopoulos; Guillaume Debaty; Tahar Chouihed; Jason Bartos; Demetris Yannopoulos

doi:10.1016/j.resplu.2023.100429

Left rib fractures during cardiopulmonary resuscitation are associated with hemodynamic variations in a pig model of cardiac arrest

Resusc Plus. 2023 Jul 14:15:100429. doi: 10.1016/j.resplu.2023.100429. eCollection 2023 Sep.

Authors

Affiliations

¹ Department of Medicine-Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.
² INSERM U 1116, University of Lorraine, Vandœuvre-lès-Nancy, France.
³ Department of Cardiothoracic Surgery, Heart Centre, University of Cologne, Cologne, Germany.
⁴ Université Grenoble Alpes, CNRS, CHU de Grenoble, TIMC-IMAG UMR 5525, Av. des Maquis du Grésivaudan, 38700 La Tronche, France.

Abstract

Background: Chest compressions (CC) are the cornerstone of cardiopulmonary resuscitation (CPR). But CC are also known to cause injuries, specifically rib fractures. The effects of such fractures have not been examined yet. This study aimed to investigate hemodynamic effects of rib fractures during mechanical CPR in a porcine model of cardiac arrest (CA).

Methods: We conducted a retrospective hemodynamic study in 31 pigs that underwent mechanical CC. Animals were divided into three groups based on the location of rib fractures: No Broken Ribs group (n = 11), Left Broken Ribs group (n = 13), and Right Broken Ribs group (n = 7). Hemodynamic measurements were taken at 10 seconds before and 10, 30, and 60 seconds after rib fractures.

Results: Baseline hemodynamic parameters did not differ between the three groups. Systolic aortic pressure was overall higher in the Left Broken Ribs group than in the No Broken Ribs group at 10, 30, and 60 seconds after rib fracture (p = 0.02, 0.01, and 0.006, respectively). The Left Broken Ribs group had a significantly higher right atrial pressure compared to the No Broken Rib group after rib fracture (p = 0.02, 0.01, and 0.03, respectively). There was no significant difference for any parameter for the Right Broken Ribs group, when compared to the No Broken Ribs group.

Conclusion: An increase in main hemodynamic parameters was observed after left rib fractures while right broken ribs were not associated with any change in hemodynamic parameters. Reporting fractures and their location seems worthwhile for future experimental studies.

Keywords: Cardiac arrest; Chest compressions; Resuscitation; Rib fractures.