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24 Injuries following mechanical cardiac massage with a piston-type device
  1. L Milling1,2,
  2. BS Astrup2,
  3. S Mikkelsen1
  1. 1Mobile Emergency Care Unit, Department of Anesthesiology and Intensive Care, Odense University Hospital, Denmark
  2. 2Institute of Forensic Medicine Odense, University of Southern Denmark, Denmark


Aim Chest injuries and abdominal injuries as a result of vigorous cardiac compression have caused concern ever since manual cardiopulmonary resuscitation was introduced.1 The same concerns have now been expressed in relation to mech-CPR.2,3 The aim of this study was to investigate injury patterns related to mech-CPR in comparison to manual CPR.

Method During a study period of 15 months, a convenience sample of all patients treated with chest compressions (CC) by the Odense MECU as well as all patients in the Region of Southern Denmark treated with mech-CPR was assessed. Prehospital discharge reports, in-hospital records, and autopsy reports were manually reviewed for indications of injuries related to CC.

Results We included 75 patients receiving mech-CPR and 234 patients receiving manual CPR. The crude analysis showed that mech-CPR posed a significantly higher risk of injuries than manual CPR (p<0.001, Odds-Ratio 3.31, CI: 1.91 to 5.74). When adjusted for duration of CPR this difference waned. Mech-CPR significantly increased the likelihood of soft tissue injuries compared with manual CPR alone. This difference was significant both in a crude analysis and adjusted for duration, age, gender, BMI and anticoagulant therapy (Odds-Ratio 31.87 (CI: 5.82 to 172.83 (p<0.001)). Furthermore, the occurrence of injuries was associated with duration of CC regardless of mech-CPR or manual CPR (Odds-Ratio 1.02 (CI: 1.00 to 1.04 (p=0.02)).

Conclusion Mech-CPR was strongly associated with soft tissue injuries. Prolonged duration of CPR was associated with increased prevalence of injuries. This finding may have implications for future on-scene treatment of patients in cardiac arrest.


  1. . Ihnat Rudinska L, Hejna P, Ihnat P, Tomaskova H, Smatanova M, Dvoracek I. Intra-thoracic injuries associated with cardiopulmonary resuscitation: Frequent and serious. Resuscitation2016;103:66–70.

  2. . Camden JR, Carucci LR. Liver injury diagnosed on computed tomography after use of an automated cardiopulmonary resuscitation device. Emerg Radiol2011;18(5):429–431.

  3. . Joseph JR, Freundlich RE, Abir M. Ruptured subcapsular liver haematoma following mechanically-assisted cardiopulmonary resuscitation. BMJ Case Rep2016;2016.

Conflict of interest None

Funding None

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