It is a common concern that performing cardiopulmonary resuscitation (CPR) might cause injuries, particularly broken ribs. This apprehension is understandable, as CPR involves applying significant force to the chest. While such injuries can occur, understanding the context and purpose of CPR is important. This article aims to clarify the reality of these potential injuries and emphasize the life-saving nature of CPR.
The Reality of Rib and Sternum Injuries
Rib fractures and sternum fractures can indeed occur during CPR. Studies indicate rib fractures are common, with prevalence rates ranging from 13% to 97% in adults, and often 32-60% in post-mortem studies. Sternal fractures are reported from 14% to 43%. These injuries are a known consequence of the force required for effective chest compressions.
The types of injuries can include fractured ribs, a fractured sternum, or the separation of cartilage connecting the ribs to the sternum. The second rib is frequently fractured in CPR-related rib injuries, occurring in about 60% of cases. Sternal fractures often happen between the third and fifth rib levels. These skeletal injuries are generally not life-threatening.
Why These Injuries Occur
Chest compressions during CPR require substantial force to circulate blood. Guidelines recommend compressing the chest 2 to 2.4 inches (5-6 cm) for adults. This depth typically requires 100 to 125 pounds (550 Newtons) of force. This pressure pumps blood from the heart to the brain and other vital organs.
The chest’s skeletal structure, including ribs and sternum, must yield to this force. Fracture risk increases with bone density and age. Older individuals or those with osteoporosis have more fragile bones, increasing susceptibility. Deep compressions inherently place pressure on these bones and cartilage, leading to potential injuries.
Prioritizing Life Over Injury
The primary objective of CPR is to save a life by maintaining blood flow to the brain and other organs when the heart has stopped. Without immediate CPR, brain damage can occur in minutes. The alternative is often death or severe brain injury.
In this context, potential rib or sternum injuries are considered a manageable side effect of a life-saving procedure. While these fractures can cause pain and take several weeks to heal, they are typically not fatal and can be treated after the person is resuscitated. The focus remains on restoring circulation and oxygen to prevent irreversible damage, making minor injuries a small price for survival.
Minimizing Risk Through Proper Technique
While injuries cannot be eliminated, proper technique reduces preventable harm. Correct hand placement is crucial: place the heel of one hand on the lower half of the sternum, in the center of the chest, with the other hand stacked on top. Keep fingers interlaced and off the chest to avoid direct rib pressure.
Compressions should be delivered at a rate of 100 to 120 per minute, to a depth of 2 to 2.4 inches (5-6 cm). Allow for full chest recoil after each compression, letting the chest return to its normal position. This allows the heart to refill with blood, ensuring effective subsequent compressions. Formal CPR training is recommended for high-quality compressions and injury minimization.