Unpredictable cardiac arrest caused by blunt cardiac injuries with sternum fracture: a case report

Blunt cardiac injury (BCI) is common in road traffic accidents due to high energy injuries to the thorax and its structures, such as the anterior and posterior of the chest wall. The severity of BCI is high enough to cause many on-site deaths. However, patients with BCI may also be asymptomatic and exhibit normal findings; thus, diagnosis can be significantly challenging for many clinicians. Moreover, since BCI can be diagnosed through multiple serial tests, it is very important to always consider the possibility of BCI in high-risk patients . Diagnosis of BCI begins with suspicion of BCI, followed by repeated electrocardiograms, echocardiography, and cardiac biomarkers measurements along with intensive observation.

Abstract 239: The Relationship Between Duration of Chest Compression and Traumatic Thoracic Injuries in Out-of-hospital Cardiac Arrest Patients

Background: Recent guidelines emphasized that high-quality chest compression is essential for improving the survival in out-of-hospital cardiac arrest (OHCA) patients. However, it may lead to critical traumatic injuries. Method: Between June. 2018 to Mar. 2019, we collected Utstein-style data on 130 consecutive adult patients with non-traumatic OHCA who were transferred to our hospital without return of spontaneous circulation (ROSC). Patients with aortic dissection and aortic aneurysmal rupture were excluded. Full-body CT scan was performed in all patients and chest compression-induced thoracic injuries were defined as rib fracture, sternum fracture, hemopneumothorax, mediastinal emphysema or intrathoracic hematoma. We identified the possible predictors for thoracic injuries and evaluated the relation between traumatic thoracic injuries and 30-day survival. Results: Patients with thoracic injuries were 105 (81%). The duration of chest compression in patients with thoracic injuries was significantly longer than that in patients without thoracic injuries (30 vs 38min, p<0.01). ROC analysis identified a duration of chest compression of 35 minutes as the optimal cutoff point for predicting thoracic injuries (sensitivity 0.59, specificity 0.83, area under the curve 0.71). Multivariate analysis revealed that age and duration of chest compression were predictors of thoracic injuries (OR 1.05, 1.07, p≦0.01, respectively). The rates of 30-day survival in patients with thoracic injuries was significantly lower than those without thoracic injuries (1 % vs 16 %, p<0.01). Conclusion: The duration of chest compression was one of the independent predictors for thoracic injuries in non-traumatic OHCA patients. Prolonger duration of chest compression are potential candidates for CT scan to diagnose thoracic injuries.

Sternum Trauma

Chapter 7 provides an overall look at sternum fracture. The sternum is a flat bone at the anterior center of the chest, which protects the mediastinum. The sternum along with the ribs and vertebrae form the thoracic cage, which protects the thoracic organs and vessels. Fractures are usually associated with direct blunt trauma which most commonly occurs during motor vehicle accidents or from vigorous cardiopulmonary resuscitation. Significant mortality may be associated with displaced sternal fractures because of aortic, cardiac, or pulmonary injury. CT examination has surpassed radiographs in the assessment of sternal fractures and adds identification of secondary findings. It has superior sensitivity to radiography and is valuable in diagnosing serious associated injuries.

Anthropological analysis of projectile trauma to the bony regions of the trunk

Ballistics literature often focuses on soft tissue injures and projectile trauma to the cranium. Minimal details on the bony characteristics of projectile trauma to the thorax/abdomen regions have been published. This study aims to analyse projectile trauma to the bony trunk region including the ribs, vertebrae, scapula, sternum and the hip bone to form a better understanding of the characteristics and biomechanics of skeletal trauma caused by a projectile and contribute to the existing database on skeletal trauma caused by projectiles. Fourteen cases of documented projectile trauma to the bony regions of the trunk from the Hamman-Todd Human Osteological Collection at the Cleveland Natural History Museum, Ohio were analysed. Of the 14 individuals with gunshot wounds examined, 40 wounds occurred to the bones. Twenty- four injuries to the ribs, 1 ilium, 11 vertebrae, 3 scapulae, and 1 sternum. Fracture patterns, heaving and bevelling can be used to determine the direction of travel of the projectile which can be evident on the ribs, sternum, scapula and ilium. It is critical to understand the wounding patterns associated with projectile trauma to the torso region as this is often targeted, due to being the centre of mass.