Deep Compressions in CPR Increases Injury Risk, But Could Preserve Brain Function

Irene Marco Clement, MS

Results of a new study are diving further into the potential risks and benefits of deep chest compressions during cardiac arrest.

An analysis of data from a 14-year period, results indicated the recommendation of deep chest compressions included in 2010 CPR guidelines increased the risk of CPR-related injuries, such as cracked ribs, but decreased the risk of brain damage among patients exposed to prolonged resuscitation.

"Deep chest compressions improve blood flow to the brain, improving survival and brain function,” said lead investigator Irene Marco Clement, MS, of University Hospital La Paz in Spain, in a statement.

Presented at the European Society of Cardiology (ESC) Congress 2020, the study was designed to assess the effects of the 3 most recent changes to CPR guidelines on outcomes among patients. With this in mind, Marco Clement and a team of Colleagues from University Hospital La Paz designed their study to assess outcomes in consecutive patients admitted to the hospital between August 2006 and January 2020.

For the purpose of analysis, investigators categorized patients into groups based on the 5-year time frame of admission—groups 1, 2, and 3 represented 2006-2010, 2011-2015, and 2016-2020, respectively. Investigators included all patients admitted with in-hospital and out-of-hospital cardiac treated with targeted temperature therapy. Of note, limited participation to comatose survivors of cardiac arrest as they were more likely to receive prolonged resuscitation.

A total of 510 patients were identified for inclusion in the statistical analysis. Of these 510, 94were included in group 1, 243 were included in group 2, and 173 were included in group 3. Investigators pointed out demographic and cardiovascular risk factors did not vary significantly between the study groups—the mean age of the total study population was 63 years and 81% were men. Data suggested CPR provided by lay bystanders (Group 1, 51.6%; Group 2, 63.3%; G3, 69.8%; P=.01) and the use of automated external defibrillators (Group 1, 11.0%; Group 2, 14.9%; G3, 18.9%; P=.04) during prehospital care progressively increased across the 3 study groups.

Upon analysis, investigators found the rate of CPR-related injuries increased following the recommendations for deep chest compression in 2010 (Group 1, 12.7%; Group 2, 23.5%; Group 3, 22.7%; P=.02). The most common CPR-related injuries reported during the study were rib or sternal fractures.

Results also indicated Cerebral Performance Category scores within a 3-month follow-up period significantly increased over time when comparing the 3 periods (P=.04). Results of the analysis suggested 65.1% of patients with CPR-related injuries had high brain function compared to 43.2% of patients without CPR-related injuries (P<.01).

"Survival and neurological outcome improved significantly during the 14-year study," added Marco Clement, in the aforementioned statement. "Members of the public increasingly came to the rescue with CPR and there was greater use of AEDs. Injuries from CPR rose, but these patients were less likely to have brain damage."

This study, “Impact of resuscitation guidelines updates on global outcomes after cardiac arrest,” was presented as part of ESC Congress 2020.