Risk factors for chest trauma associated with prehospital mechanical chest compression after non-traumatic out-of-hospital cardiac arrest in a South Korean regional registry.

BACKGROUND

Mechanical chest compression devices are increasingly used during cardiopulmonary resuscitation, particularly in the prehospital setting, where maintaining high-quality manual chest compressions is challenging. In this study, we aimed to determine whether prehospital exposure to mechanical chest compression is independently associated with increased risk of compression-related chest trauma among out-of-hospital cardiac arrest (OHCA) survivors.

METHODS

We retrospectively analyzed patients from our prospective OHCA registry who achieved sustained return of spontaneous circulation and underwent chest computed tomography (CT) between March 2019 and June 2023. Chest trauma was identified on imaging and categorized as rib fractures, lung contusion, pneumothorax, pneumomediastinum, hematoma, sternal fracture, or hemothorax. Multivariate logistic regression was performed to identify factors associated with chest trauma.

RESULTS

Among 634 included patients, 614 (97%) underwent chest CT, and 277 (45.1%) had evidence of chest trauma. Patients with chest trauma were more likely to be female, be older, have lower body mass index, undergo longer resuscitation, and receive prehospital mechanical chest compression. Rib fractures were the most common injury, followed by sternal fracture. Multivariate analysis showed that the use of mechanical compression in the prehospital setting was an independent risk factor for compression-related chest trauma (adjusted odds ratio, 2.33; 95% CI, 1.45- 3.74).

CONCLUSIONS

Exposure to mechanical chest compression in the prehospital setting was independently associated with an increased risk of compression-related chest trauma among OHCA survivors.