Cardiopulmonary Resuscitation (CPR) is a life-saving technique used when someone’s heart has stopped beating. A common concern is the potential for injuries, particularly broken ribs. Understanding these realities is important for anyone who might need to perform CPR.
Understanding Rib Fractures During CPR
Rib and sternal fractures can occur during CPR. These injuries are a known consequence of the forceful chest compressions required to circulate blood. A systematic review found CPR-related injuries in 60% of patients, with rib fractures being the most common, observed in 55% of cases. While common, these fractures are typically not life-threatening.
Autopsy data suggests even higher percentages, with 86% of men and 91% of women showing skeletal injuries, and 77% of men and 85% of women having broken ribs. These frequent injuries are often minor, such as cracked ribs, which are painful but usually heal with rest and pain management.
The Mechanics Behind Injuries
Rib and sternal fractures occur during CPR due to the significant force needed for effective chest compressions. To manually pump blood to vital organs, compressions must be applied with adequate depth and force. For adults, this means compressing the chest at least 2 inches (5 to 6 cm) deep.
The chest wall comprises the ribs, sternum, and connecting cartilage. When substantial, repetitive force is applied, it can exceed the bones’ and cartilage’s capacity, leading to fractures, separations, or bruising. The anterior ribs, the direct impact site, are particularly susceptible. These injuries are often an unavoidable part of life-saving compressions.
Ensuring Proper CPR Technique
Correct CPR technique can help minimize injury while maximizing compression effectiveness. Proper hand placement is on the lower half of the sternum, in the center of the chest, avoiding the xiphoid process at the bottom of the breastbone. The heel of one hand is placed in this position, with the other hand directly on top, fingers interlaced and lifted.
Compressions should be delivered straight down, with shoulders directly over the hands and elbows locked, to achieve the recommended depth. The compression rate should be 100 to 120 compressions per minute, allowing for full chest recoil to ensure the heart refills with blood. Formal CPR training, adhering to guidelines from organizations like the American Heart Association (AHA), is important for learning and practicing these techniques to enhance effectiveness and reduce harm.
The Greater Purpose of CPR
Despite the risk of injury, CPR remains a life-saving intervention. In cardiac arrest, the alternative to CPR is often death, as the heart has stopped circulating blood. The potential for injuries is a small, acceptable risk when weighed against the chance of survival.
The primary goal of CPR is to maintain blood flow and oxygen to the brain and heart until professional medical help arrives. Injuries are typically managed by medical professionals in post-resuscitation care. Continuing compressions even if a cracking sound is heard is important, as maintaining blood flow is paramount.