Aim

There have been no direct comparisons of cardiopulmonary resuscitation (CPR)-related injuries between those who die during CPR and those who survive to intensive care unit (ICU) admission. This study aimed to compare the incidence, severity, and impact on survival rate of these injuries and potential influencing factors.

Method

This retrospective multicenter study analyzed autopsy reports of patients who experienced out-of-hospital cardiac arrest (OHCA) and were not admitted to hospital. CPR-related injuries were compared to OHCA patients with clinical suspicion of CPR-related injury confirmed on imaging when admitted to the ICU.

Results

A total of 859 out-of-hospital cardiac arrests (OHCA) were divided into 2 groups: those who died during CPR and underwent autopsy (DEAD [n = 628]); and those who experienced return of spontaneous circulation and admitted to the ICU (ICU [n = 231]). Multivariable analyses revealed that independent factors of 30-day mortality included no bystander arrest, cardiac etiology, no shockable rhythm, and CPR-related injury. Trauma was independently associated with older age, bystander CPR, cardiac etiology, duration of CPR, and no defibrillation. CPR-related injury occurred in 30 (13%) patients in the ICU group and 547 (87%) in the DEAD group (p < 0.0001). Comparison of injuries revealed that those in the DEAD group experienced more thoracic injuries, rib(s) and sternal fractures, and fewer liver injuries compared to those in the ICU group, without differences in injury severity.

Conclusion

CPR-related injuries were observed more frequently in those who died compared with those who survived to ICU admission. Injury was an independent factor of 30-day mortality.

中文翻译：

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非创伤性院外心脏骤停后的 CPR 相关损伤：幸存者与非幸存者

目的

没有直接比较心肺复苏术（CPR）相关损伤在心肺复苏期间死亡的患者和幸存到重症监护病房（ICU）的患者。本研究旨在比较这些损伤的发生率、严重程度和对生存率的影响以及潜在的影响因素。

方法

这项回顾性多中心研究分析了经历过院外心脏骤停 (OHCA) 且未入院的患者的尸检报告。将 CPR 相关损伤与临床怀疑 CPR 相关损伤的 OHCA 患者进行比较，这些患者在入住 ICU 时影像学证实。

结果

总共 859 例院外心脏骤停 (OHCA) 被分为 2 组：在 CPR 期间死亡并接受尸检的患者 (DEAD [n = 628])；以及那些经历了自主循环恢复并入住 ICU 的人 (ICU [n = 231])。多变量分析显示，30 天死亡率的独立因素包括无旁观者逮捕、心脏病因、无可电击节律和 CPR 相关损伤。创伤与年龄较大、旁观者心肺复苏术、心脏病因、心肺复苏术持续时间和无除颤独立相关。ICU 组 30 名 (13%) 患者和 DEAD 组 547 名 (87%) 患者发生 CPR 相关损伤 (p < 0.0001)。损伤比较显示，与 ICU 组相比，DEAD 组的胸部损伤、肋骨和胸骨骨折更多，肝损伤更少，

结论

与存活到 ICU 的患者相比，死亡患者的 CPR 相关损伤更常见。损伤是 30 天死亡率的独立因素。