Incidence of Traumatic Injuries Sustained Following Cardiopulmonary Resuscitation: A Single-Centre Retrospective Cohort Study

Background Chest compressions form the basis of cardiopulmonary resuscitation (CPR) in out of hospital cardiac arrest (OHCA). Recently, mechanical CPR (MCPR) devices have been introduced, particularly in the prehospital environment, avoiding the need for clinicians to perform conventional manual CPR (CCPR). At our institution, extracorporeal membrane oxygenation (ECMO) is available for select OHCA patients in refractory arrest (ECPR). Given ECPR patients typically undergo prolonged chest compressions, there may be a higher likelihood of injury; however, evidence directly comparing ECPR and CCPR injury rates is lacking. This study aimed to investigate incidence and type of traumatic injuries following CPR and whether a difference between ECPR and CCPR patients exists. Results 313 OHCA were identified between 2021-2024, with 136 meeting criteria. Mean CPR duration was 24±16 minutes, and 37 patients (27%) received MCPR. Thirteen patients had ECPR with mean time from cardiac arrest to establishment of ECMO blood flow being 63±18 minutes, of which 11 (85%) received MCPR. Injuries occurred in 58 patients (43%), with 23 (16.9%) sustaining clinically significant injuries. Rates of mortality were higher for the injured patients compared to the non-injured patients (41 [70%] vs 33 [43%] respectively, p = ≤0.05 ). On multiple variable logistic regression analysis CPR >20 minutes, not ECPR or MCPR, was significantly associated with traumatic injury (OR 2.45, CI 1.15, 5.23, p = ≤0.05 ). Conclusion CPR-related injuries are common. CPR >20 minutes, not ECPR or MCPR, is associated with higher rate of injury. CT imaging in this cohort could be considered to identify these injuries.