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

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];  = 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.