Work

Low bone mineral density increases the risk of multiple rib and sternal fractures during cardiopulmonary resuscitation

Year: 2025

Type: article

Abstract: BACKGROUND: The correlation between low bone mineral density (BMD) and an increased risk of skeletal fractures is well-established. Rib and sternal fractures are common following cardiopulmonary resuscitation (CPR). However, it is unclear to what extent BMD corelates to the risk of rib and sternal fractures following CPR. AIM: The study aims to identify how BMD and different CPR modalities for chest compression (CC) (bystander, professionals, mechanical) are risk factors for rib and sternal fractures in a forensic autopsy population. MATERIALS AND METHODS: Postmortem computed tomography (PMCT) was used for volumetric BMD estimation. All cases were retrieved from a database of cases referred for medicolegal autopsy, who had received antemortem CPR. The number of rib and sternal fractures across CC-modalities and BMD-groups were compared using negative binomial regressions models, while the frequency of rib and sternal fractures was compared with Fisher's Exact Test. RESULTS: The data revealed a higher frequency and number of rib and sternal fractures (fracture count (FC)) among cases with low BMD, regardless of age (BMD-osteopenia FC-ratio: 1.3 (1.0-1.6), BMD-osteoporotic: FC-ratio: 1.4 (1.0-1.9), compared to BMD-normal). In general, the frequency and number of rib and sternal fractures was the same across CC-modalities. A tendency towards lowest frequency and number of rib and sternal fractures was observed among bystander CC (Bystander frequency: 43 % and FC-mean: 5.3 (3.1-9.3) vs. other CC-modality where frequency and FC-mean were at least 76 % and 7.2 (5.3-9.7)). In cases with normal BMD, the addition of mechanical chest compression statistically significantly increased the frequency of rib and sternal fractures (Manual: 63.3 % vs. Manual + Mechanical: 88.0 %, Fisher's Exact Test: 0.021). CONCLUSION: The study identified a statistically significant correlation between low BMD and a higher number of rib and sternal fractures after CPR. Further, in cases with normal BMD, the use of mechanical CC increased the frequency of rib and sternal fractures.

Source: Resuscitation

DOI: 10.1016/j.resuscitation.2025.110952

Authors: Dennis Vinther, Lene Warner Thorup Boel, Lars Uhrenholt, Kasper Hansen

Institution: Aarhus University

Language: English

Topic: Cardiac Arrest and Resuscitation

Subfield: Emergency Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,490