Chest Compression-Related Flail Chest Is Associated with Prolonged Ventilator Weaning in Cardiac Arrest Survivors.
Kevin KunzSirak PetrosSebastian EwensMaryam Yahiaoui-DoktorTimm DeneckeManuel Florian StruckSebastian KraemerPublished in: Journal of clinical medicine (2022)
Chest compressions during cardiopulmonary resuscitation (CPR) may be associated with iatrogenic chest wall injuries. The extent to which these CPR-associated chest wall injuries contribute to a delay in the respiratory recovery of cardiac arrest survivors has not been sufficiently explored. In a single-center retrospective cohort study, surviving intensive care unit (ICU) patients, who had undergone CPR due to medical reasons between 1 January 2018 and 30 June 2019, were analyzed regarding CPR-associated chest wall injuries, detected by chest radiography and computed tomography. Among 109 included patients, 38 (34.8%) presented with chest wall injuries, including 10 (9.2%) with flail chest. The multivariable logistic regression analysis identified flail chest to be independently associated with the need for tracheostomy (OR 15.5; 95% CI 2.77-86.27; p = 0.002). The linear regression analysis identified pneumonia (β 11.34; 95% CI 6.70-15.99; p < 0.001) and the presence of rib fractures (β 5.97; 95% CI 1.01-10.93; p = 0.019) to be associated with an increase in the length of ICU stay, whereas flail chest (β 10.45; 95% CI 3.57-17.33; p = 0.003) and pneumonia (β 6.12; 95% CI 0.94-11.31; p = 0.021) were associated with a prolonged duration of mechanical ventilation. Four patients with flail chest underwent surgical rib stabilization and were successfully weaned from the ventilator. The results of this study suggest that CPR-associated chest wall injuries, flail chest in particular, may impair the respiratory recovery of cardiac arrest survivors in the ICU. A multidisciplinary assessment may help to identify patients who could benefit from a surgical treatment approach.
Keyphrases
- cardiac arrest
- cardiopulmonary resuscitation
- mechanical ventilation
- intensive care unit
- computed tomography
- acute respiratory distress syndrome
- healthcare
- young adults
- magnetic resonance imaging
- end stage renal disease
- chronic kidney disease
- newly diagnosed
- quality improvement
- patient reported outcomes
- prognostic factors
- positron emission tomography