Abstract 9056: The Association Between Thoracic Injuries Due to Chest Compression and Short-Term Prognosis in Patients With Non-traumatic Out-of-Hospital Cardiac Arrest
Background: The current guidelines emphasize that high-quality chest compression is essential for improving the survival in out-of-hospital cardiac arrest (OHCA) patients. However, it may lead to thoracic injuries which is a potential factor of poor prognosis. Method: Between June 2017 to July 2019, we collected Utstein-style data on 384 consecutive adult patients with non-traumatic OHCA who were transferred to our hospital. Full-body CT scan was performed and thoracic injuries were defined as rib fracture, sternum fracture, hemorrhagic pleural effusion, pneumothorax, sternum posterior bleeding, mediastinal hematoma, or mediastinal emphysema. We identified the predictors for thoracic injuries and evaluated the relationship between thoracic injuries and prognosis. Results: Patients with thoracic injuries (Group-T) were 234 (76%). The duration of chest compression in Group-T was 43 min, which was significantly longer than that in patients without thoracic injuries (Group-N, 32 min, p<0.001). ROC curve analysis identified a duration of chest compression of 35 minutes as the optimal cut off for predicting thoracic injuries (area under the curve 0.73). Multivariate analysis revealed that age (OR: 1.03, 95%CI: 1.01-1.05, p=0.005) and duration of chest compression (OR: 1.07, 95%CI: 1.04-1.09, p<0.001) were independent predictors of thoracic injuries. The rate of obtaining return of spontaneous circulation (ROSC), 30-day survival and favorable neurologic outcome were larger in Group-N than Group-T. In patients with achieving ROSC, Kaplan-Meier curves showed a significantly higher cumulative survival rates in Group-N compared to that in Group-T during follow-up of 30 days (Log-rank test p=0.009). Conclusion: Age and duration of chest compression were independent predictors for thoracic injuries due to chest compression in non-traumatic OHCA patients. Moreover, the presence of thoracic injuries was associated with poor short-term prognosis.