LAUSR

Introduction: Chest wall injury (CWI) following cardiopulmonary resuscitation (CPR) is often encountered particularly in aging patients. This encompasses rib fractures, costal cartilage disruptions, and sternal fracture. Prone ventilation theoretically could exacerbate these injuries, leading to poor pulmonary mechanics or paradoxical chest wall motion. Surgical stabilization of rib fractures (SSRF) carries benefit in the trauma population for multiple fracture patterns, including flail chest. We present the case of surgical stabilization of an unstable CWI following non-traumatic arrest and subsequent prone ventilation. Description: A 57-year-old male, found down, presented in cardiopulmonary arrest presumably from overdose without obvious trauma. Successful return of spontaneous circulation was achieved after 3 rounds of ACLS. Immediate course was complicated by adult respiratory distress syndrome (ARDS) requiring prone ventilation. By hospital day 7, his encephalopathy had cleared however demonstrated paradoxical chest wall movement precluding extubation. CT revealed bilateral anterolateral rib fractures, costal cartilage disruptions, and a mid-body sternal fracture contributing to an anterior flail chest. Surgical stabilization was subsequently performed via an inframammary approach with titanium plates to stabilize bilateral rib fractures, costal cartilage injuries, and additionally sternal fracture. Patient was extubated on post-operative day 2 and transitioned out of the critical care setting on post-operative day 7 (secondary to delirium). Hospital course was complicated by a methicillin-sensitive staphylococcal pneumonia and superficial wound infection that were treated with cefazolin. Patient was discharged to skilled rehabilitation and has no apparent hardware complications at 6-week follow-up Discussion: SSRF has shown benefit to trauma patients with flail chest and severely displaced rib fractures. Cardiopulmonary resuscitation has the potential to cause similar injury patterns, particularly anterior flail chest. While outcomes following CPR are often poor, if neurologic and functional outcome is obtainable then our case illustrates the utility of surgical stabilization of an unstable CWI in a non-trauma patient that promoted rapid ventilator liberation and avoided tracheostomy.