45 - Complications of CPR

Summary

Introduction

Cardiopulmonary resuscitation is an invasive medical treatment. Its measures can cause more or less severe complications, which often remain unrevealed unless autopsy is performed.

Performing sufficient chest compressions needs regular thumps with force up to 392 N (40 kp). The human thorax, the ribs, and especially the sternum are not built for such force and will frequently suffer iatrogenic injuries. If the patient 's biological age is unknown, the occurrence of some of these injuries cannot be avoided. In the last decades, a number of chest compression devices have been developed to increase cardiac output and to replace the rescuer 's hands and his/her manpower. Although some of these devices are already commercially available, there is a general lack of information on their adverse effects in comparison to manual chest compression.

Defibrillation constitutes one of the most invasive resuscitative measures. Complications of defibrillation may affect the patient, the rescuers, and the immediate environment. Although systematic investigations have rarely been conducted, the available evidence will be discussed in the corresponding paragraph.

Time is critical in CPR, and medical personnel as well as lay rescuers generally work under emotional pressure. Moreover, CPR is frequently performed under challenging conditions, such as at night, in uncomfortable weather conditions, environmental dangers, inadequate manpower, noise, in a confined space, and other adverse circumstances, which in particular, are found in the prehospital setting. Therefore, it is understandable that, for example, endotracheal intubation has to be performed under conditions that are considerably worse than in the OR and therefore cause harm more frequently. Meticulous autopsy can find macro- and micro-lesions caused by intubation maneuvers.