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J Korean Soc Emerg Med > Volume 26(5); 2015 > Article
Journal of The Korean Society of Emergency Medicine 2015;26(5): 409-416.
병원내 심정지 환자의 심폐소생술로 인한 흉부 골격계 손상에 영향을 미치는 요인
조재철1, 서영우1, 김균무1, 이경우1, 최대해2, 장태창1
1대구가톨릭대학교 의과대학 응급의학교실
2동국대학교 의과대학 응급의학교실
Factors Associated with Skeletal Chest Injuries Secondary to Cardiopulmonary Resuscitation of In-Hospital Cardiac Arrest Patients
Jae Chul Cho1, Young Woo Seo1, Gyunmoo Kim1, Kyung Woo Lee1, Dai Hai Choi2, Tae Chang Jang1
1Department of Emergency Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
2Department of Emergency Medicine, Dongguk University of School of Medicine, Gyeongbuk, Korea
Correspondence  Tae Chang Jang ,Tel: 053) 650-4282, Fax: 053) 650-4930, Email: emzzang@cu.ac.kr,
Received: June 25, 2015; Revised: June 30, 2015   Accepted: August 22, 2015.  Published online: October 30, 2015.
ABSTRACT
Purpose:
Rib and sternal fractures are common complications of chest compressions during cardiopulmonary resuscitation (CPR). The aim of this study is to investigate skeletal chest injuries following chest compressions and factors associated with skeletal chest injuries.
Method:
A retrospective study was conducted for 10 years from January 2005 to February 2015. Skeletal chest injuries in patients who underwent computerized tomography (CT) after return of spontaneous circulation (ROSC) were analyzed. The exclusion criteria were patients with insufficient medical records, under 18 years old, traumatic cardiac arrest, and out-of-hospital cardiac arrest.
Results:
During the period 106 patients were included. The CT scan after ROSC showed that 47 patients (44.3%) had rib fractures, and 20 patients (18.9%) had sternal fractures. The rib fracture group showed higher age (73 vs 61, p<0.001), longer CPR time (10 vs 6 min, p<0.001), and higher incidence of sternal fracture (34% vs 6.8%, p<0.001). The sternal fracture group showed longer CPR time (10 vs 7, p<0.05) and higher incidence of rib fractures (80% vs 4.7%, p<0.001). In multivariate logistic regression analysis, age (OR 1.087; 95% CI 1.041 to 1.134, p<0.001), CPR time (OR 1.200; 95% CI 1.087 to 1.323, p<0.001), and sternal fracture (OR 4.524; 95% CI 1.259 to 16.697, p=0.021) showed significant association with rib fracture.
Conclusion:
Rib and sternal fractures are frequent complications in patients who underwent CPR. In hospital cardiac arrest patients with older age, longer CPR time, and sternal fracture needed more precaution for rib fractures and other complications.
Key words: Rib fractures, Sternal fractures, Cardiopulmonary resuscitation, Heart arrest
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