CPR-induced trauma: Comparison of three manual methods in an experimental model

Karl B Kern, Alice B. Carter, Russel L. Showen, William D. Voorhees, Charles F. Babbs, Willis A. Tacker, Gordon A. Ewy

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Cardiopulmonary resuscitation (CPR) often results in traumatic injury to the patient. Differences in CPR-induced trauma among various forms of manual, external CPR, however, are unknown. We compared CPR-induced trauma among manual standard (STD) CPR at 60 compressions per minute; high-impulse compression (HIC) CPR at 120 compressions per minute; and interposed abdominal compression (IAC) CPR at 60 compressions per minute. A large (24 ± 3 kg) mongrel canine model was used. Ten animals were assigned to each type of CPR. Each received 17 minutes of CPR, applied to produce the best possible coronary perfusion pressure without obviously damaging the dog. Defibrillation was attempted at 20 minutes. Necropsy was performed at the time of death or after sacrifice at 24 hours. Careful postmortem examination of the thorax, lungs, heart, abdomen, and great vessels was performed. A semiquantitative trauma score of 0 to 5 was assigned to each area with a possible maximal score of 25. There was no difference in trauma scores among STD (6.4 ± 1.5), HIC (9.4 ± 1.4), and IAC (8.1 ± 1.3) methods. No significant correlation was found between the method of CPR and the different types of trauma. Specifically, IAC did not produce an increase in liver lacerations nor did HIC produce a significant increase in thoracic or pulmonary injuries. Six of 20 initially resuscitated animals expired during the 24-hour follow-up period due to CPR-induced injuries. Four of these six had extensive pulmonary trauma, including pulmonary hemorrhage or edema. Liver lacerations were the second most lethal injury. We conclude that external CPR commonly produces trauma, including serious injury in more than 25% of all recipients. There were no statistical differences in amount or type of trauma produced among STD, HIC, or IAC CPR. The most serious injuries produced were pulmonary hemorrhage and hepatic lacerations.

Original languageEnglish (US)
Pages (from-to)674-679
Number of pages6
JournalAnnals of Emergency Medicine
Volume15
Issue number6
DOIs
StatePublished - 1986
Externally publishedYes

Fingerprint

Cardiopulmonary Resuscitation
Theoretical Models
Wounds and Injuries
Lacerations
Lung
Liver
Hemorrhage
Thoracic Injuries
Lung Injury
Abdomen
Canidae
Autopsy
Edema
Thorax
Perfusion

Keywords

  • complications
  • CPR
  • CPR-induced
  • experimental
  • experimental trauma

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Kern, K. B., Carter, A. B., Showen, R. L., Voorhees, W. D., Babbs, C. F., Tacker, W. A., & Ewy, G. A. (1986). CPR-induced trauma: Comparison of three manual methods in an experimental model. Annals of Emergency Medicine, 15(6), 674-679. https://doi.org/10.1016/S0196-0644(86)80424-3

CPR-induced trauma : Comparison of three manual methods in an experimental model. / Kern, Karl B; Carter, Alice B.; Showen, Russel L.; Voorhees, William D.; Babbs, Charles F.; Tacker, Willis A.; Ewy, Gordon A.

In: Annals of Emergency Medicine, Vol. 15, No. 6, 1986, p. 674-679.

Research output: Contribution to journalArticle

Kern, KB, Carter, AB, Showen, RL, Voorhees, WD, Babbs, CF, Tacker, WA & Ewy, GA 1986, 'CPR-induced trauma: Comparison of three manual methods in an experimental model', Annals of Emergency Medicine, vol. 15, no. 6, pp. 674-679. https://doi.org/10.1016/S0196-0644(86)80424-3
Kern, Karl B ; Carter, Alice B. ; Showen, Russel L. ; Voorhees, William D. ; Babbs, Charles F. ; Tacker, Willis A. ; Ewy, Gordon A. / CPR-induced trauma : Comparison of three manual methods in an experimental model. In: Annals of Emergency Medicine. 1986 ; Vol. 15, No. 6. pp. 674-679.
@article{6befd4dbaf8344b89e798b2fd1625f1f,
title = "CPR-induced trauma: Comparison of three manual methods in an experimental model",
abstract = "Cardiopulmonary resuscitation (CPR) often results in traumatic injury to the patient. Differences in CPR-induced trauma among various forms of manual, external CPR, however, are unknown. We compared CPR-induced trauma among manual standard (STD) CPR at 60 compressions per minute; high-impulse compression (HIC) CPR at 120 compressions per minute; and interposed abdominal compression (IAC) CPR at 60 compressions per minute. A large (24 ± 3 kg) mongrel canine model was used. Ten animals were assigned to each type of CPR. Each received 17 minutes of CPR, applied to produce the best possible coronary perfusion pressure without obviously damaging the dog. Defibrillation was attempted at 20 minutes. Necropsy was performed at the time of death or after sacrifice at 24 hours. Careful postmortem examination of the thorax, lungs, heart, abdomen, and great vessels was performed. A semiquantitative trauma score of 0 to 5 was assigned to each area with a possible maximal score of 25. There was no difference in trauma scores among STD (6.4 ± 1.5), HIC (9.4 ± 1.4), and IAC (8.1 ± 1.3) methods. No significant correlation was found between the method of CPR and the different types of trauma. Specifically, IAC did not produce an increase in liver lacerations nor did HIC produce a significant increase in thoracic or pulmonary injuries. Six of 20 initially resuscitated animals expired during the 24-hour follow-up period due to CPR-induced injuries. Four of these six had extensive pulmonary trauma, including pulmonary hemorrhage or edema. Liver lacerations were the second most lethal injury. We conclude that external CPR commonly produces trauma, including serious injury in more than 25{\%} of all recipients. There were no statistical differences in amount or type of trauma produced among STD, HIC, or IAC CPR. The most serious injuries produced were pulmonary hemorrhage and hepatic lacerations.",
keywords = "complications, CPR, CPR-induced, experimental, experimental trauma",
author = "Kern, {Karl B} and Carter, {Alice B.} and Showen, {Russel L.} and Voorhees, {William D.} and Babbs, {Charles F.} and Tacker, {Willis A.} and Ewy, {Gordon A.}",
year = "1986",
doi = "10.1016/S0196-0644(86)80424-3",
language = "English (US)",
volume = "15",
pages = "674--679",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - CPR-induced trauma

T2 - Comparison of three manual methods in an experimental model

AU - Kern, Karl B

AU - Carter, Alice B.

AU - Showen, Russel L.

AU - Voorhees, William D.

AU - Babbs, Charles F.

AU - Tacker, Willis A.

AU - Ewy, Gordon A.

PY - 1986

Y1 - 1986

N2 - Cardiopulmonary resuscitation (CPR) often results in traumatic injury to the patient. Differences in CPR-induced trauma among various forms of manual, external CPR, however, are unknown. We compared CPR-induced trauma among manual standard (STD) CPR at 60 compressions per minute; high-impulse compression (HIC) CPR at 120 compressions per minute; and interposed abdominal compression (IAC) CPR at 60 compressions per minute. A large (24 ± 3 kg) mongrel canine model was used. Ten animals were assigned to each type of CPR. Each received 17 minutes of CPR, applied to produce the best possible coronary perfusion pressure without obviously damaging the dog. Defibrillation was attempted at 20 minutes. Necropsy was performed at the time of death or after sacrifice at 24 hours. Careful postmortem examination of the thorax, lungs, heart, abdomen, and great vessels was performed. A semiquantitative trauma score of 0 to 5 was assigned to each area with a possible maximal score of 25. There was no difference in trauma scores among STD (6.4 ± 1.5), HIC (9.4 ± 1.4), and IAC (8.1 ± 1.3) methods. No significant correlation was found between the method of CPR and the different types of trauma. Specifically, IAC did not produce an increase in liver lacerations nor did HIC produce a significant increase in thoracic or pulmonary injuries. Six of 20 initially resuscitated animals expired during the 24-hour follow-up period due to CPR-induced injuries. Four of these six had extensive pulmonary trauma, including pulmonary hemorrhage or edema. Liver lacerations were the second most lethal injury. We conclude that external CPR commonly produces trauma, including serious injury in more than 25% of all recipients. There were no statistical differences in amount or type of trauma produced among STD, HIC, or IAC CPR. The most serious injuries produced were pulmonary hemorrhage and hepatic lacerations.

AB - Cardiopulmonary resuscitation (CPR) often results in traumatic injury to the patient. Differences in CPR-induced trauma among various forms of manual, external CPR, however, are unknown. We compared CPR-induced trauma among manual standard (STD) CPR at 60 compressions per minute; high-impulse compression (HIC) CPR at 120 compressions per minute; and interposed abdominal compression (IAC) CPR at 60 compressions per minute. A large (24 ± 3 kg) mongrel canine model was used. Ten animals were assigned to each type of CPR. Each received 17 minutes of CPR, applied to produce the best possible coronary perfusion pressure without obviously damaging the dog. Defibrillation was attempted at 20 minutes. Necropsy was performed at the time of death or after sacrifice at 24 hours. Careful postmortem examination of the thorax, lungs, heart, abdomen, and great vessels was performed. A semiquantitative trauma score of 0 to 5 was assigned to each area with a possible maximal score of 25. There was no difference in trauma scores among STD (6.4 ± 1.5), HIC (9.4 ± 1.4), and IAC (8.1 ± 1.3) methods. No significant correlation was found between the method of CPR and the different types of trauma. Specifically, IAC did not produce an increase in liver lacerations nor did HIC produce a significant increase in thoracic or pulmonary injuries. Six of 20 initially resuscitated animals expired during the 24-hour follow-up period due to CPR-induced injuries. Four of these six had extensive pulmonary trauma, including pulmonary hemorrhage or edema. Liver lacerations were the second most lethal injury. We conclude that external CPR commonly produces trauma, including serious injury in more than 25% of all recipients. There were no statistical differences in amount or type of trauma produced among STD, HIC, or IAC CPR. The most serious injuries produced were pulmonary hemorrhage and hepatic lacerations.

KW - complications

KW - CPR

KW - CPR-induced

KW - experimental

KW - experimental trauma

UR - http://www.scopus.com/inward/record.url?scp=0022551885&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022551885&partnerID=8YFLogxK

U2 - 10.1016/S0196-0644(86)80424-3

DO - 10.1016/S0196-0644(86)80424-3

M3 - Article

C2 - 3706858

AN - SCOPUS:0022551885

VL - 15

SP - 674

EP - 679

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 6

ER -