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Войти в исследования Resuscitation · 2025
Impact of chest wall injuries after cardiopulmonary resuscitation in non-traumatic and successfully resuscitated cardiac arrest: insights from the DISCAR study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Nemlaghi-Zdiri Marwa, Lacoste-Palasset Thomas, Dahmani Sirine, Lefevre Thomas, Haudebourg Luc, Voicu Sebastian, M'rad Aymen, Lehalleur Adrien Pepin, Sutterlin Laetitia, Ekherian Jean-Michel, Malissin Isabelle, Nguyen Philippe, Megarbane Bruno, Deye Nicolas
Аннотация
BACKGROUND: 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.
AIM: To investigate the role of CWI on outcomes, 28-day-survival with ventilator-free-days, duration of hospitalization, and identify factors associated with CWI.
METHODS: 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].
RESULTS: 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.
INTERPRETATION: CWI in successfully resuscitated UCA patients are frequent, clinically largely underdiagnosed, and may be associated with lower 28-day-survival with ventilator-free-days.
AIM: To investigate the role of CWI on outcomes, 28-day-survival with ventilator-free-days, duration of hospitalization, and identify factors associated with CWI.
METHODS: 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].
RESULTS: 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.
INTERPRETATION: CWI in successfully resuscitated UCA patients are frequent, clinically largely underdiagnosed, and may be associated with lower 28-day-survival with ventilator-free-days.