Impact of chest wall injuries after cardiopulmonary resuscitation in non-traumatic and successfully resuscitated cardiac arrest: insights from the DISCAR study.

Abstract

Chest wall injuries (CWI) including anterior flail segment, rib and sternal fractures are recognized complications of cardiopulmonary resuscitation (CPR) after unexpected cardiac arrest (UCA). Their impact remains poorly investigated. To investigate the role of CWI on outcomes, 28-day-survival with ventilator-free-days, duration of hospitalization, and identify factors associated with CWI. Were included in a monocentric observational study all consecutive non-traumatic adult patients hospitalized in ICU for a successfully resuscitated UCA, excluding patients requiring extracorporeal life support or dying within the first 48 h following admission. Patients were categorized as having CWI based on hospitalization reports and/or on available chest CT-scans, all systematically reanalyzed. Results are expressed as percentage, median [interquartile 25-75]. Were included 383 UCA patients (60 [49-72] y.o, 30 % female, and 41 % experiencing initial shockable rhythm). UCA was of hypoxic and cardiac origin in 21 % and 45 %, respectively. Chest CT-scan was performed in 174 patients (45 %). CWI were diagnosed in 101 patients (26 %): 4 only clinically, 87 with CT-scan alone, and 10 with both concordant information. CWI patients had a significant lower 28-day-survival with ventilator-free-days than non-CWI patients (P < 0.001), and an increased in-ICU length of stay (P = 0.017). In multivariable analysis, age, bystander CPR, no-flow and low-flow durations, shockable rhythm, but not CWI, were independently associated with survival with favourable neurological outcome. Older age, prolonged low-flow duration, and hypoxic UCA were independently associated with CWI. CWI in successfully resuscitated UCA patients are frequent, clinically largely underdiagnosed, and may be associated with lower 28-day-survival with ventilator-free-days.