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

In a prospective study of 38 cadavers of patients older than 18 without pre vious chest injury or cardiopulmonary resuscitation (CPR), active compressi on-decompression (ACD) resuscitation manoeuvres were performed to determine possible factors influencing sternal and/or rib fractures. ACD was perform ed for 60 s, with compression and decompression forces being continuously r ecorded. A stepwise logistic regression analysis was applied. Factors analy zed were age, gender, use of a compression cushion beneath the piston of th e ACD device (Ambu CardioPump(R)), and maximal compression and decompressio n forces. After ACD, the cadavers were autopsied and thoracic injuries were assessed. There was a significant correlation between sternal fractures an d 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 patie nts had a higher risk for rib fractures. Maximal compression force was anot her factor in sternal and/or rib fracture (P = 0.048). Even though a signif icantly higher incidence of sternal fractures was observed when the compres sion cushion was used (P = 0.045), inclusion of this variable in the regres sion analysis only marginally improved the prediction for correct classific ation of sternal fractures. In conclusion, when well controlled ACD-CPR is performed in cadavers, age is the most important factor determining the inc idence of rib fracture. Sternal fractures were more common in female cadave rs. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.