Rib fractures after chest compressions for cardiac arrest: retrospective analysis of the AfterROSC1 and AfterROSC2 multicenter databases

Abstract

Purpose

External chest compressions for resuscitation after out-of-hospital cardiac arrest (OHCA) can cause rib fractures, which are best diagnosed by computed tomography (CT). We assessed the prevalence, management, and associations with outcomes of CT-documented rib fractures in patients with OHCA.

Methods

We retrospectively analyzed data collected prospectively at five AfterROSC Network centers in 2020–2023. We included consecutive patients with return of spontaneous circulation and coma after non-traumatic OHCA who underwent CT within 6 h after admission. Rib fractures and other chest-wall injuries were recorded. Associations with the day-90 functional outcome were sought. Analgesic treatment was compared between patients with 0–2 vs. ≥3 rib fractures.

Results

Of 2129 patients, 233 (11%) underwent chest CT, which showed at least one rib fracture in 116 (50%). The mean number of rib fractures was 2.4 ± 3.4 and the median was 0 [0–4]. One patient had clinical flail chest. In patients with ≥3 rib fractures, the mean modified Cardiac Arrest Hospital Prognosis (mCAHP) score was higher (91 ± 23 vs. 82 ± 25) and a favorable day-90 neurological outcome (modified Rankin Scale score 0–3) was significantly less common, even after adjustment on mCAHP (18% vs. 35%; adjusted odds ratio, 0.37 [0.19–0.72]; P = 0.003). Analgesic therapy was not significantly different between patients with 0–2 and ≥3 rib fractures.

Conclusions

Rib fractures related to chest compressions are common in OHCA survivors. Having ≥3 rib fractures was associated with a poorer prognosis after adjustment on cardiac-arrest characteristics. The management of pain related to rib fractures may require reappraisal.