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Original Article
CPR/Resuscitation Risk factors for chest trauma associated with prehospital mechanical chest compression after non-traumatic out-of-hospital cardiac arrest in a South Korean regional registry
Acute and Critical Care 2026;41(2):356-363.
DOI: https://doi.org/10.4266/acc.002225
Published online: May 28, 2026

Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding author: Won Young Kim Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3350 Fax: +82-2-3010-3360 Email: wonpia73@naver.com
• Received: July 7, 2025   • Revised: December 26, 2025   • Accepted: February 10, 2026

© 2026 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Background
    Mechanical chest compression devices are increasingly used during cardiopulmonary resuscitation, particularly in the prehospital setting, where maintaining high-quality manual chest compressions is challenging. In this study, we aimed to determine whether prehospital exposure to mechanical chest compression is independently associated with increased risk of compression-related chest trauma among out-of-hospital cardiac arrest (OHCA) survivors.
  • Methods
    We retrospectively analyzed patients from our prospective OHCA registry who achieved sustained return of spontaneous circulation and underwent chest computed tomography (CT) between March 2019 and June 2023. Chest trauma was identified on imaging and categorized as rib fractures, lung contusion, pneumothorax, pneumomediastinum, hematoma, sternal fracture, or hemothorax. Multivariate logistic regression was performed to identify factors associated with chest trauma.
  • Results
    Among 634 included patients, 614 (97%) underwent chest CT, and 277 (45.1%) had evidence of chest trauma. Patients with chest trauma were more likely to be female, be older, have lower body mass index, undergo longer resuscitation, and receive prehospital mechanical chest compression. Rib fractures were the most common injury, followed by sternal fracture. Multivariate analysis showed that the use of mechanical compression in the prehospital setting was an independent risk factor for compression-related chest trauma (adjusted odds ratio, 2.33; 95% CI, 1.45–3.74).
  • Conclusions
    Exposure to mechanical chest compression in the prehospital setting was independently associated with an increased risk of compression-related chest trauma among OHCA survivors.
  • Key Words: cardiopulmonary resuscitation; mechanical chest compression; out-of-hospital cardiac arrest
Out-of-hospital cardiac arrest (OHCA) is a significant public health burden worldwide, with an estimated incidence ranging from 24 to 186 per 100,000 population and 46.8 per 100,000 in Korea [1]. Despite advances in emergency medical service (EMS) and post-cardiac arrest care, overall survival rates have shown little improvement over recent decades [2]. Current guidelines emphasize high-quality cardiopulmonary resuscitation (CPR), including appropriate depth, rate, full recoil, and minimal interruptions [3]. However, the quality of manual chest compressions is highly operator-dependent and can be easily compromised by rescuer fatigue, inadequate training, and environmental constraints, particularly in the prehospital setting and during transport [4,5].
Mechanical chest compression devices have been introduced to address these limitations and are now widely used in the prehospital setting, due to their advantages in minimizing rescuer fatigue and interruptions [6]. Their use increased during the coronavirus disease 2019 (COVID-19) pandemic, as personal protective equipment made manual compressions more difficult for healthcare providers [7]. Nevertheless, the clinical benefit and safety of mechanical compression devices remain controversial [8]. While some retrospective studies suggest improved hemodynamic parameters with mechanical compressions, recent randomized controlled trials have found no significant survival benefits compared with manual CPR [9-11]. Moreover, earlier studies reported a higher incidence of CPR-related chest injuries associated with mechanical compressions, which may contribute to adverse outcomes such as pneumonia, fewer ventilator-free days, and increased mortality [12,13]. Due to limitations such as small sample sizes and study designs, the relationship between mechanical compressions and chest trauma remains unclear [14,15]. Moreover, most previous studies have evaluated mechanical CPR as a uniform intervention without considering the clinical context in which it is applied. Mechanical chest compression devices are frequently deployed in the prehospital setting under uncontrolled and dynamic conditions, whereas initiation after hospital arrival generally occurs in a more controlled environment with immediate clinical oversight and the capacity for appropriate device adjustment [16]. These differences suggest that prehospital exposure to mechanical chest compression, rather than mechanical CPR itself, may be a key determinant of compression-related chest trauma. Accordingly, in this study, we focus on prehospital mechanical compression to better clarify its relationship with chest trauma.
The Institutional Review Board of Asan Medical Center approved this research (No. 2025-0867) and waived the requirement for informed consent due to its retrospective observational design.
Study Design, Setting, and Population
We conducted a single-center, retrospective study between March 1, 2019, and June 30, 2023, at a university-affiliated teaching hospital in Seoul, Korea. The hospital’s emergency department (ED) handles approximately 120,000 visits annually. Our hospital maintains a registry of all consecutive adult patients (aged ≥18 years) who present to the ED with OHCA for the purposes of clinical monitoring and research [17]. Patients with do-not-resuscitate (DNR) orders or terminal medical illnesses are excluded from the registry. For this study, we further excluded patients with traumatic cardiac arrest (e.g., resulting from traffic accidents, falls, drowning, or hanging) and those who did not achieve sustained return of spontaneous circulation (ROSC), defined as the absence of a palpable pulse for over 20 minutes, since post-mortem chest imaging is not performed at our institution.
In South Korea, EMS providers are not authorized to declare death in the field, except in cases where patients show obvious signs of death. EMS personnel are categorized as level 1 or level 2 providers, roughly equivalent to EMS-Intermediate and EMT-Basic levels in the United States, respectively. Each ambulance station has its own protocol for the use of mechanical compression devices. All EMS providers are permitted to use mechanical chest compression devices in the prehospital setting. These devices operate via different mechanisms, including systems that deliver compressions using a load-distributing band across the chest and systems that apply direct, piston-driven compressions to the anterior chest wall, without direct guidance from a medical doctor [18]. Typically, EMS teams initiate mechanical compression during transport, and emergency physicians continue its use after the patient arrives at the ED, until CPR is terminated. Patients were classified according to whether a mechanical compression device was applied during prehospital resuscitation: cases in which manual compression was performed in the prehospital setting and mechanical compression was initiated only after ED arrival were categorized into the no prehospital mechanical compression group. Mechanical compression devices in the prehospital setting are typically applied after initial manual CPR. However, in rare circumstances (e.g., no bystander CPR), EMS providers may initiate CPR using the mechanical device. Therefore, in this study patients were categorized based on any prehospital exposure to a mechanical compression device, regardless of whether manual CPR preceded device application.
Data Collection
Detailed OHCA-related data were extracted from the previously mentioned prospective CPR registry at our hospital. For each case, the emergency medicine physician on duty recorded CPR information in the electronic medical records using the Utstein template, and the data were subsequently reviewed and entered into a web-based registry. Collected data included patient demographics, prehospital CPR duration, ED CPR duration, total CPR time, presence of ROSC achieved by EMS, use of defibrillation by EMS, and whether a mechanical compression device was used. Clinical outcomes such as hospital length of stay, in-hospital death, and good neurological recovery (defined as Cerebral Performance Category 1-2) at discharge were also extracted.
All enrolled patients routinely underwent chest computed tomography (CT) following sustained ROSC. A board-certified radiologist on duty retrospectively reviewed the imaging and reported findings using standardized terminology to characterize chest trauma. Two investigators then reviewed images and categorized predefined injuries, including rib fractures, sternal fracture, lung contusion, pneumothorax/pneumomediastinum, and hematoma/hemothorax. Additionally, approximately 30% of the images were randomly assigned to an emergency medicine physician who was blinded to the original reports for independent assessment. Agreement between the radiologist’s reports and the blinded reviewer was evaluated. Chest trauma was considered present if any trauma-related findings were documented in the report.
Statistical Analysis
All categorical variables were reported as counts with percentages and analyzed using the chi-square test or Fisher’s exact test, as appropriate. Continuous variables were presented as medians with interquartile ranges, and the normality of their distributions was assessed using the Kolmogorov-Smirnov test. Comparisons between patients with and without chest trauma were performed using the Mann-Whitney U-test. To assess relationships between chest trauma and various clinical variables, multivariate logistic regression analysis was conducted using a backward stepwise method. Before constructing the multivariate model, multicollinearity among candidate variables was evaluated using the variance inflation factor (VIF), and no significant multicollinearity was observed. Age and body mass index (BMI) were dichotomized based on clinically relevant cut-off values: age ≥65 years was categorized as older age, and BMI ≥25 kg/m² was classified as obesity, and both were entered into the model as categorical variables. Adjusted odds ratios and 95% CIs were calculated. Variables with a P-value <0.1 in the univariate logistic regression analysis were included in the multivariate model. A two-sided P-value <0.05 was considered statistically significant. All statistical analyses were performed using IBM SPSS Statistics for Windows version 23 (IBM Corp.).
Study Population
A total of 1,667 adult patients with OHCA presented to the ED during the study period (Figure 1). Of these, 614 patients achieved sustained ROSC and underwent chest CT following resuscitation. Mechanical compression-related trauma was identified in 277 patients (45.1%).
Baseline characteristics of the study population are summarized in Table 1. The majority of patients were male (68.1%), and the median age was 65 years. Compared with patients with chest trauma, those without chest trauma were more likely to be male (72.1% vs. 63.2%), younger (median age, 63.0 vs. 67.0 years), and have a higher BMI (23.5 vs. 21.9 kg/m²). Patients without trauma were more likely to have cardiovascular disease (54.0% vs. 39.4%) but less likely to have had cerebrovascular disease (3.9% vs. 9.0%) and pulmonary disease (5.8% vs. 12.1%) compared to those with trauma. In addition, patients without trauma had significantly shorter prehospital CPR times (18.0 vs. 24.0 minutes), ED CPR times (5.0 vs. 8.0 minutes), and total CPR durations (24.0 vs. 32.0 minutes). Consistent with these findings, the rate of EMS-achieved ROSC was higher in the non-trauma group than in the trauma group (36.8% vs. 21.7%). Among the entire cohort, 136 patients (22.1%) received prehospital mechanical chest compressions, and 199 patients (32.4%) received ED-only mechanical compressors. The incidence of trauma was significantly higher in those who underwent prehospital mechanical compression compared to manual compression (32.5% vs. 13.6%), but not in those who underwent ED-only mechanical compression (33.6% vs. 31.5%). The ED-only mechanical compression group included 199 patients (32.4%), and no significant differences were observed between this group and the comparator group.
Detailed chest CT findings after ROSC are presented in Table 2. Rib fractures were observed more frequently in the prehospital mechanical compression group compared with the no prehospital mechanical compression group (30.1% vs. 22.8%, P=0.08). Sternal fractures also occurred slightly more often in the prehospital mechanical compression group (25.9% vs. 25.3%), but this difference was not statistically significant (P=0.47). In contrast, lung contusion was significantly more common among patients who received prehospital mechanical compression in the prehospital setting (26.5% vs. 13.6%, P<0.01). The rates of pneumothorax/pneumomediastinum (4.4% vs. 3.6%, P=0.65) and hematoma/hemothorax (2.9% vs. 1.9%, P=0.45) did not differ significantly between the two groups. Clinical outcomes are summarized in Supplementary Table 1. Patients with chest trauma had shorter hospital length of stay (2 days vs. 5 days), higher in-hospital death (49.5% vs. 40.1%), and worse neurological recovery at discharge (15.5% vs. 31.4%).
Univariate logistic regression analysis identified male sex, age, BMI, cardiovascular disease, cerebrovascular disease, pulmonary disease, prehospital CPR time, ED CPR time, total CPR time, EMS ROSC, and prehospital mechanical compression as factors significantly associated with chest trauma (all P<0.05) (Table 3). Multicollinearity was identified among prehospital CPR time, ED CPR time, and total CPR time. Therefore, only prehospital CPR time, which is clinically related to the application of a mechanical compression device in the prehospital setting, was included in the analysis. We also assessed multicollinearity between prehospital CPR time and prehospital mechanical compression, and no significant collinearity was observed (VIF=1.136). In the multivariate logistic regression model, BMI ≥25 kg/m² (adjusted OR, 0.48; 95% CI, 0.27–0.85; P<0.01) and cardiovascular disease (adjusted OR, 0.52; 95% CI, 0.29–0.94; P<0.03) were associated with lower odds of chest trauma. In contrast, prehospital resuscitation time (adjusted OR, 1.03; 95% CI, 1.00–1.05; P<0.01), and prehospital mechanical compression (adjusted OR, 2.33; 95% CI, 1.45–3.74; P<0.01) were independently associated with the occurrence of chest trauma.
In this retrospective cohort study of adult OHCA survivors who achieved sustained ROSC, we found that exposure to mechanical chest compression in the prehospital setting was independently associated with an increased risk of compression-related chest trauma. Mechanical chest compression devices are designed to deliver consistent compressions and reduce rescuer fatigue. However, their real-world application in the prehospital environment is complex. During transport, device placement and stability may be compromised by patient movement, limited access for repositioning, and the absence of continuous physician supervision [16]. In contrast, mechanical compression initiated in the ED is typically performed under controlled circumstances, with immediate clinical feedback and the ability to promptly correct suboptimal positioning [16]. This contextual distinction provides a plausible explanation for why prehospital exposure, rather than mechanical compression per se, emerged as a significant factor associated with chest trauma in our analysis. Accordingly, our results should be interpreted as highlighting the importance of appropriate device application, training, and situational awareness in the prehospital setting, rather than as evidence against the use of mechanical chest compression devices in general. Future studies should further explore how environmental factors, provider experience, and device management during transport influence the risk of CPR-related injuries.
The incidence of compression-related injuries reported in this study is lower than that in previous studies, including large population-based meta-analyses, which have reported rates as high as 70-80% for both manual and mechanical compressions [14,19]. This discrepancy is likely attributable to differences in study populations and diagnostic methods. In contrast to many prior studies, which primarily included non-surviving patients, our study focused on patients who achieved ROSC. Because patients who achieved ROSC were generally younger and had a shorter duration of CPR compared with those who did not, the overall incidence of chest trauma might have been lower in this group, suggesting a potential for selection bias. From a clinical perspective, compression-induced chest injuries are particularly relevant for patients who survive cardiac arrest, as these injuries may influence their subsequent recovery and outcomes. However, there is a relative lack of data specifically examining the incidence and consequences of chest trauma in this subgroup. Our findings underscore the importance of further research to understand the potential impact of CPR-related injuries on the clinical trajectory of OHCA survivors.
In this study, we found that rib fractures were the most frequent injury (54.1%), followed by sternal fracture (49.1%), lung contusion (36.4%), pneumothorax or pneumomediastinum (8.3%), and hematoma or hemothorax (4.7%). The incidence and proportion of rib fractures were comparable to those reported in a previous study from Switzerland involving 335 patients [20]. The prevalence of other injuries was also similar to previous reports, with the exception of sternal fractures, which appeared to be underestimated in our study [21,22]. Exposure to prehospital mechanical compression devices was clearly associated with higher incidence of lung contusion, whereas the rates of other injuries were similar between the two groups. However, in this study we could not determine the definitive effect of mechanical compression on chest injury because the design did not allow for a direct comparison between mechanical-only and manual-only CPR.
In addition to prehospital mechanical compression, several clinical factors were independently associated with chest trauma. Higher BMI (≥25 kg/m²) was inversely associated with the occurrence of chest trauma, which may reflect the cushioning effect of increased soft tissue over the thoracic cage, potentially reducing focal stress and fracture risk during chest compressions [23]. Similarly, the presence of cardiovascular disease was associated with a lower likelihood of chest trauma. Although the underlying mechanism is unclear, this finding may be related to differences in patient characteristics, resuscitation circumstances, or compression dynamics in this population rather than a direct protective effect. In contrast, longer prehospital resuscitation time was associated with an increased risk of chest trauma, suggesting that prolonged or cumulative mechanical stress during CPR may contribute to thoracic injury [24]. These findings highlight that both patient-related factors and resuscitation duration influence the risk of chest trauma and should be considered when interpreting CPR-related injuries.
There are several limitations to this study. First, the findings may have limited generalizability, as this was a single-center retrospective study. Second, only patients who achieved sustained ROSC were included, introducing potential selection bias. However, we intentionally focused on this subgroup because CPR-related injuries are clinically most relevant among survivors, in whom such injuries may influence subsequent management and outcomes. Third, this study was not designed to directly compare mechanical-only versus manual-only chest compressions. Mechanical chest compression devices were frequently applied after an initial period of manual CPR, particularly in the prehospital setting, making it difficult to isolate the independent effect of mechanical compression alone. Therefore, our findings should not be interpreted as establishing a causal relationship between mechanical CPR itself and chest trauma. Instead, they reflect an association with prehospital exposure to mechanical compression within real-world resuscitation workflows. Fourth, we were unable to differentiate injury patterns according to specific types of mechanical compression devices, because detailed device-level data were not consistently available. Given that these devices are often used interchangeably in clinical practice, we analyzed them as a combined group. However, device-specific effects on chest injury risk warrant further investigation. Finally, unmeasured confounding factors may remain, including variability in bystander CPR quality, EMS provider experience, and device positioning or displacement during transport. Although we adjusted for key clinical and resuscitation-related variables, residual confounding cannot be entirely excluded.
This study was designed to determine the incidence and risk factors for compression-related chest trauma among adult OHCA survivors, with a particular focus on prehospital exposure to mechanical chest compression. Compression-related chest injury was relatively common in this population, and prehospital application of mechanical chest compression was independently associated with an increased risk of such injuries. These findings should not be interpreted as evidence that mechanically delivered CPR itself is inherently harmful, but rather emphasize the importance of appropriate device application and training in the prehospital setting.
▪ This study was conducted to determine the incidence and risk factors for compression-related chest trauma among adult out-of-hospital cardiac arrest survivors, with a particular focus on prehospital exposure to mechanical chest compression.
▪ Compression-related chest injury was relatively common, occurring in 45.1% of cases, and prehospital application of mechanical chest compression was independently associated with an increased risk of such injury.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

None.

ACKNOWLEDGMENTS

None.

AUTHOR CONTRIBUTIONS

Conceptualization: JSK, HP, WYK. Data curation: JSK, HP. Formal analysis: JSK. Methodology: JSK, WYK. Visualization: JSK. Writing–original draft: JSK. Writing–review & editing: JSK, WYK. All authors read and agreed to the published version of the manuscript.

Supplementary materials can be found via https://doi.org/10.4266/acc.002225.
Supplementary Table 1.
Clinical outcomes according to chest trauma
acc-002225-Supplementary-Table-1.pdf
Figure 1.
Study flowchart. OHCA: out-of-hospital cardiac arrest; IHCA: in-hospital cardiac arrest; ROSC: return of spontaneous circulation; CT: computed tomography.
acc-002225f1.jpg
Table 1.
Baseline characteristics of the study population according to chest trauma
Variable Total (n = 614) No trauma (n = 337) Trauma (n = 277) P-value
Male 418 (68.1) 243 (72.1) 175 (63.2) 0.02
Age (yr) 65.0 (53.0–76.0) 63.0 (53.0–74.0) 67.0 (52.0–78.0) 0.03
BMI (kg/m2) 22.9 (20.7–24.9) 23.5 (20.8–26.0) 21.9 (19.6–24.2) <0.01
Bystander CPR 419 (68.2) 238 (70.6) 181 (65.3) 0.16
Past illnesses
 Cardiovascular disease 291 (47.5) 182 (54.0) 109 (39.4) 0.03
 Cerebrovascular disease 38 (6.2) 13 (3.9) 25 (9.0) 0.01
 Pulmonary disease 44 (7.2) 28 (5.8) 16 (12.1) <0.01
 Endocrine disease 151 (24.6) 83 (24.6) 68 (24.5) 0.98
 Renal disease 52 (8.5) 34 (10.1) 18 (6.5) 0.11
 Malignancy 62 (10.1) 36 (10.7) 26 (9.4) 0.60
Prehospital CPR time (min) 21.0 (12.0–28.0) 18.0 (8.0–25.0) 24.0 (16.0–30.1) <0.01
ED CPR time (min) 6.5 (0.0–12.0) 5.0 (0.0–11.0) 8.0 (3.0–13.0) <0.01
Total CPR time (min) 28.0 (14.5–40.0) 24.0 (12.0–36.0) 32.0 (22.0–45.0) <0.01
EMS ROSC 184 (30.0) 124 (36.8) 60 (21.7) <0.01
EMS shock 93 (15.1) 49 (14.5) 44 (15.9) 0.64
Prehospital mechanical compressor 136 (22.1) 46 (13.6) 90 (32.5) <0.01
ED-only mechanical compressor 199 (32.4) 106 (31.5) 93 (33.6) 0.58

Values are presented as number (%) or median (interquartile range).

BMI: body mass index; CPR: cardiopulmonary resuscitation; ED: emergency department; EMS: emergency medical service; ROSC: return of spontaneous circulation.

Table 2.
Detailed trauma-related findings on chest CT after ROSC
Variable Total No prehospital mechanical compressor Prehospital mechanical compressor P-value
Rib fracture 150 (54.1) 109 (22.8) 41 (30.1) 0.08
Sternal fracture 136 (49.1) 121 (25.3) 15 (25.9) 0.47
Lung contusion 101 (36.4) 65 (13.6) 36 (26.5) <0.01
Pneumothorax/pneumomediastinum 23 (8.3) 17 (3.6) 6 (4.4) 0.65
Hematoma/hemothorax 13 (4.7) 9 (1.9) 4 (2.9) 0.45

Values are presented as number (%).

CT: computed tomography; ROSC: return of spontaneous circulation.

Table 3.
Univariate and multivariate logistic regression for predicting chest trauma
Variable Univariate Multivariate
OR 95% CI P-value Adjusted OR 95% CI P-value
Male 0.68 0.43–1.07 0.10 - - -
Age >65 yr 0.87 0.55–1.37 0.54 - - -
BMI ≥25 kg/m2 0.49 0.27–0.88 0.02 0.48 0.27–0.85 0.01
Cardiovascular disease 0.54 0.30–0.98 0.04 0.52 0.29–0.94 0.03
Cerebrovascular disease 0.88 0.35–2.17 0.78 - - -
Pulmonary disease 1.32 0.60–2.91 0.49 - - -
Prehospital CPR time 1.02 1.00–1.04 0.02 1.03 1.00–1.05 <0.01
EMS ROSC 0.67 0.39–1.14 0.14 - - -
Prehospital mechanical compression 2.23 1.37–3.63 < 0.01 2.33 1.45–3.74 <0.01

OR: odds ratio; BMI: body mass index; CPR: cardiopulmonary resuscitation; EMS: emergency medical service; ROSC: return of spontaneous circulation.

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        Risk factors for chest trauma associated with prehospital mechanical chest compression after non-traumatic out-of-hospital cardiac arrest in a South Korean regional registry
        Acute Crit Care. 2026;41(2):356-363.   Published online May 28, 2026
        DOI: https://doi.org/10.4266/acc.002225
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      Risk factors for chest trauma associated with prehospital mechanical chest compression after non-traumatic out-of-hospital cardiac arrest in a South Korean regional registry
      Image
      Figure 1. Study flowchart. OHCA: out-of-hospital cardiac arrest; IHCA: in-hospital cardiac arrest; ROSC: return of spontaneous circulation; CT: computed tomography.

      Figure 1.

      Risk factors for chest trauma associated with prehospital mechanical chest compression after non-traumatic out-of-hospital cardiac arrest in a South Korean regional registry
      Variable Total (n = 614) No trauma (n = 337) Trauma (n = 277) P-value
      Male 418 (68.1) 243 (72.1) 175 (63.2) 0.02
      Age (yr) 65.0 (53.0–76.0) 63.0 (53.0–74.0) 67.0 (52.0–78.0) 0.03
      BMI (kg/m2) 22.9 (20.7–24.9) 23.5 (20.8–26.0) 21.9 (19.6–24.2) <0.01
      Bystander CPR 419 (68.2) 238 (70.6) 181 (65.3) 0.16
      Past illnesses
       Cardiovascular disease 291 (47.5) 182 (54.0) 109 (39.4) 0.03
       Cerebrovascular disease 38 (6.2) 13 (3.9) 25 (9.0) 0.01
       Pulmonary disease 44 (7.2) 28 (5.8) 16 (12.1) <0.01
       Endocrine disease 151 (24.6) 83 (24.6) 68 (24.5) 0.98
       Renal disease 52 (8.5) 34 (10.1) 18 (6.5) 0.11
       Malignancy 62 (10.1) 36 (10.7) 26 (9.4) 0.60
      Prehospital CPR time (min) 21.0 (12.0–28.0) 18.0 (8.0–25.0) 24.0 (16.0–30.1) <0.01
      ED CPR time (min) 6.5 (0.0–12.0) 5.0 (0.0–11.0) 8.0 (3.0–13.0) <0.01
      Total CPR time (min) 28.0 (14.5–40.0) 24.0 (12.0–36.0) 32.0 (22.0–45.0) <0.01
      EMS ROSC 184 (30.0) 124 (36.8) 60 (21.7) <0.01
      EMS shock 93 (15.1) 49 (14.5) 44 (15.9) 0.64
      Prehospital mechanical compressor 136 (22.1) 46 (13.6) 90 (32.5) <0.01
      ED-only mechanical compressor 199 (32.4) 106 (31.5) 93 (33.6) 0.58
      Variable Total No prehospital mechanical compressor Prehospital mechanical compressor P-value
      Rib fracture 150 (54.1) 109 (22.8) 41 (30.1) 0.08
      Sternal fracture 136 (49.1) 121 (25.3) 15 (25.9) 0.47
      Lung contusion 101 (36.4) 65 (13.6) 36 (26.5) <0.01
      Pneumothorax/pneumomediastinum 23 (8.3) 17 (3.6) 6 (4.4) 0.65
      Hematoma/hemothorax 13 (4.7) 9 (1.9) 4 (2.9) 0.45
      Variable Univariate Multivariate
      OR 95% CI P-value Adjusted OR 95% CI P-value
      Male 0.68 0.43–1.07 0.10 - - -
      Age >65 yr 0.87 0.55–1.37 0.54 - - -
      BMI ≥25 kg/m2 0.49 0.27–0.88 0.02 0.48 0.27–0.85 0.01
      Cardiovascular disease 0.54 0.30–0.98 0.04 0.52 0.29–0.94 0.03
      Cerebrovascular disease 0.88 0.35–2.17 0.78 - - -
      Pulmonary disease 1.32 0.60–2.91 0.49 - - -
      Prehospital CPR time 1.02 1.00–1.04 0.02 1.03 1.00–1.05 <0.01
      EMS ROSC 0.67 0.39–1.14 0.14 - - -
      Prehospital mechanical compression 2.23 1.37–3.63 < 0.01 2.33 1.45–3.74 <0.01
      Table 1. Baseline characteristics of the study population according to chest trauma

      Values are presented as number (%) or median (interquartile range).

      BMI: body mass index; CPR: cardiopulmonary resuscitation; ED: emergency department; EMS: emergency medical service; ROSC: return of spontaneous circulation.

      Table 2. Detailed trauma-related findings on chest CT after ROSC

      Values are presented as number (%).

      CT: computed tomography; ROSC: return of spontaneous circulation.

      Table 3. Univariate and multivariate logistic regression for predicting chest trauma

      OR: odds ratio; BMI: body mass index; CPR: cardiopulmonary resuscitation; EMS: emergency medical service; ROSC: return of spontaneous circulation.

      Table 1.

      Table 2.

      Table 3.

      ACC : Acute and Critical Care
      © The Korean Society of Critical Care Medicine.
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