How Often Are Ribs Broken During CPR?

Rib fractures happen in the majority of adults who receive CPR. Study after study puts the rate somewhere between 65% and 85%, depending on the population, the imaging method used, and whether compressions were delivered by hand or by machine. One whole-body CT study found that 85% of cardiac arrest patients had rib fractures, with an average of more than eight broken ribs per person. These numbers are much higher than most people expect, and the reality is that effective chest compressions require enough force to deform the ribcage by at least five centimeters in an adult, so some skeletal damage is almost unavoidable.

The Numbers Across Studies

The exact rate depends on how carefully you look. Studies that rely on plain chest X-rays tend to undercount, while those using CT scans or autopsy catch more fractures. A whole-body CT study of cardiac arrest patients found rib fractures in 85% of subjects, with a mean of 8.5 fractures per person and sternal fractures in about 31%.¹ A large autopsy-based study reported even higher numbers: skeletal chest injuries in 86% of men and 91% of women, with rib fractures specifically in 77% of men and 85% of women.² A separate study of manual CPR recipients found rib fractures in 77% of cases, with sternal fractures in 38%.³

These percentages might sound alarming, but they reflect a fundamental trade-off. The depth of compression needed to generate adequate blood flow during cardiac arrest is substantial, and the human ribcage, especially in older adults, often cannot absorb that force without cracking. The fractures are a predictable side effect of an intervention that is keeping blood moving to the brain.

Who Is Most at Risk

Age is the single biggest predictor of rib fractures during CPR. Older patients have less elastic rib cartilage and, frequently, lower bone density. A cadaver study found a significant correlation between rib fractures and age, concluding that age was the most important factor determining fracture incidence during well-controlled compressions.⁴ A 2025 study added nuance by measuring bone mineral density directly: patients with osteopenia had about 30% more fractures than those with normal bone density, and osteoporotic patients had about 40% more, regardless of age.⁵

Sex matters too, but the pattern differs by fracture type. The large autopsy study found that women had higher rates of both rib fractures (85% versus 77% in men) and sternal fractures (79% versus 59%).² The cadaver study confirmed that women carried a higher risk specifically for sternal fractures.⁴ These differences likely reflect the higher prevalence of osteoporosis among older women, which thins both the ribs and the breastbone.

Duration of CPR also plays a role. One study found that the length of resuscitation was the only procedural factor positively correlated with injuries.⁶ This makes intuitive sense: more minutes of compressions means more repetitive loading on the same bones.

Where the Breaks Happen

CPR-related rib fractures follow a consistent pattern. The fractures cluster along the front of the ribcage, at or near the points where the ribs connect to the cartilage that joins them to the breastbone. One CT-based study found that all patients with rib fractures had anterior arc fractures, and none had posterior fractures.⁷ This makes mechanical sense: when the rescuer pushes down on the center of the chest, the force bows the ribs outward and snaps them at their weakest point, which is the anterior arc where bone transitions to cartilage.

Sternal fractures, when they occur, tend to hit the middle of the breastbone, roughly between the third and fourth ribs. A detailed analysis found that half of all sternal fractures landed in that zone, and patients who fractured the sternum also had significantly more rib fractures, averaging 13 per person compared to fewer in those without sternal involvement.⁸ The anterior fractures from CPR were typically straight, undisplaced breaks, meaning the bone cracked but did not shift out of alignment. This pattern distinguishes them from traumatic rib fractures caused by, say, a car crash, which tend to be displaced and can occur anywhere along the rib.

Manual Compressions Versus Mechanical Devices

Mechanical CPR devices, such as the LUCAS system, deliver compressions with consistent force and rate, which sounds like it should be gentler on the ribcage. In practice, it tends to be the opposite. One study found rib fractures in about 65% of patients receiving manual CPR compared to 79% of those getting mechanical compressions.⁹ A study of survivors found an even starker gap: rib fractures in 77% of manual CPR cases versus 96% with the LUCAS device, along with much higher rates of sternal fracture and severe soft tissue injury in the mechanical group.³

A CT-based comparison confirmed the pattern: 100% of mechanically resuscitated patients showed CPR-related injuries versus about 84% of those resuscitated manually, with significantly more displaced rib fractures, sternal fractures, bleeding complications, pneumothorax, and liver injuries in the mechanical group.¹⁰ A systematic review and meta-analysis broadly agreed, finding that mechanical and manual compressions produced similar rates of sternal fractures and organ injuries overall, but that manual compressions carried a lower risk of posterior rib fractures and heart and liver injuries compared to mechanical devices.¹¹

Why would a machine be rougher than human hands? Mechanical devices maintain full compression depth continuously and never fatigue, while a person’s compression depth tends to drift shallower over time. The relentless consistency of the machine actually subjects the ribcage to a larger cumulative force. Some devices also apply compressions at slightly different points on the sternum than a human rescuer would, which can redirect force into areas of the chest wall that are more vulnerable to fracture.

Guideline Changes and Fracture Rates

CPR guidelines have been revised several times over the past few decades, and the trend has been toward deeper, faster compressions. The 2010 guidelines in particular shifted the recommended compression depth from “approximately 4-5 cm” to “at least 5 cm” in adults and raised the recommended rate. A retrospective study compared fracture rates before and after the 2010 guideline change and found a significant increase in rib fractures: about 63% of patients in the pre-2010 group had rib fractures versus 79% in the post-2010 group.¹² Sternal fracture rates did not change significantly between the two periods.

A systematic review confirmed this broader trend, noting that CPR guidelines have evolved since they were first described in 1960 and that deeper compressions are likely to produce more skeletal injuries.¹³ The rationale for deeper compressions is straightforward: they generate better blood flow and improve survival. Guideline bodies have made a deliberate trade-off, accepting more fractures in exchange for more lives saved.

Children Are a Different Story

Rib fractures from CPR are far less common in children and infants. A systematic review of data on 923 children who underwent CPR found only three cases of CPR-related rib fractures, and all three occurred along the front of the chest.¹⁴ No child in that review had a posterior rib fracture from CPR. This is because children’s ribs are far more flexible than adults’ ribs: the bones are less calcified and bend rather than snap under pressure.

The picture has shifted somewhat since 2005, when pediatric CPR guidelines were revised to recommend the two-thumb encircling technique for infant CPR at a higher compression depth-to-chest ratio. A study found that CPR-related rib fractures in infants became statistically more frequent after those guideline changes, rising from a handful to 19 cases (about 3.3%) in the study population.¹⁵ Still, the overall rate remains low. A separate study looking specifically at the two-thumb technique found no rib fractures visible on chest X-ray, and concluded that rib fractures after infant CPR remain uncommon enough that their discovery should prompt a full investigation for child abuse.¹⁶

That last point carries serious clinical weight. In pediatric forensic medicine, posterior rib fractures in infants are considered a strong indicator of inflicted injury. Because CPR almost never produces posterior fractures in children, finding them should not be written off as a CPR complication.

Do CPR Fractures Threaten Survival?

The reassuring finding from the literature is that rib and sternal fractures from CPR rarely cause fatal internal organ damage.¹⁷ Most CPR-related fractures are undisplaced and anterior, meaning the broken rib ends do not puncture the lungs or lacerate abdominal organs the way a high-energy trauma fracture might. That said, the injuries are not inconsequential for survivors. A study of out-of-hospital cardiac arrest survivors found that those with chest wall injuries had fewer ventilator-free days and a higher in-hospital mortality rate compared to those without chest injuries. Among patients with good neurological recovery, having six or more rib fractures or even a single displaced fracture was associated with longer hospital and ICU stays.¹⁸

Interpreting that mortality figure requires caution. Patients who sustained more chest wall injuries also tended to receive longer resuscitation, which often indicates a more severe initial cardiac arrest. The injuries and the higher mortality may both be consequences of a harder resuscitation rather than the injuries themselves causing death.

Long-Term Recovery in Survivors

For people who survive cardiac arrest and walk out of the hospital, the long-term outlook for CPR-related chest injuries is generally good. A follow-up study of survivors found that none had persistent chest pain at the time of assessment, though two patients reported local discomfort. Lung function and thoracic expansion were measurably reduced compared to expected values, but this did not translate into clinically severe limitation for most patients. Those who had received mechanical CPR in addition to manual CPR had lower peak expiratory flow, and those with flail chest (a condition where multiple adjacent ribs break in two places, creating a free-floating segment) had less range of motion in the thoracic spine.¹⁹ Three patients in that study still had unhealed injuries at follow-up, but the overall picture was that broken ribs from CPR heal and do not typically leave people with chronic pain or disability.

How Fractures Get Counted (and Missed)

The wide range of reported fracture rates partly reflects how the fractures are detected. A plain chest X-ray misses a lot: undisplaced fractures and cartilage-level breaks are nearly invisible on standard films. CT scans are better, but even post-mortem CT and autopsy each miss some fractures the other catches. One study found 339 rib fractures across 62 patients using both methods combined, with CT identifying 69 fractures that autopsy missed and autopsy identifying 50 that CT missed.²⁰ CT was better at picking up incomplete fractures (hairline cracks), while autopsy was better at finding fractures along the back of the ribcage and in the upper and lower ribs.

Newer imaging technology is closing this gap. A study using photon-counting CT, a next-generation scanner with much higher resolution, found slightly improved sensitivity compared to conventional post-mortem CT, reaching about 92% detection in some assessments versus 82% for standard scanning.²¹ For living survivors, the practical takeaway is that if your post-arrest chest X-ray looks clean, that does not mean your ribs are intact. A CT scan is far more reliable if there is clinical suspicion of fractures.

Does Skill Level Matter?

One common worry is that bystander CPR, performed by someone with minimal training, might cause more damage than CPR delivered by a paramedic. A study comparing injuries from prehospital CPR delivered by trained first responders versus professional practitioners found no statistical difference in injury patterns between the two groups.²² A separate study found that hospitals where non-physicians participated in emergency department CPR more often had higher fracture rates, but that difference was confounded by the fact that those hospitals also treated older patients on average.²³

The bottom line is that rib fractures are driven mostly by the physics of compressing a human chest deeply and repeatedly, not by whether the person doing the compressing has a medical degree. A well-trained bystander compressing to the right depth will produce a similar injury profile to a paramedic compressing to the same depth.

Fear of Causing Injury as a Barrier to Bystander CPR

The high rate of rib fractures during CPR feeds a real psychological barrier. Surveys of lay bystanders consistently identify fear of causing harm as one of the top reasons people hesitate to start CPR on a stranger. A study of public perceptions found that fear of causing injury was specifically cited as a reason people were less likely to perform CPR on women, alongside fears about inappropriate touching and accusations of sexual assault.²⁴

Research into what helps people overcome that hesitation points to one key piece of knowledge: understanding beforehand that intervening is crucial for survival and cannot cause substantial harm relative to the alternative. Bystanders who reported this prior knowledge were more likely to act.²⁵ And the evidence supports that framing: a person in cardiac arrest will die without CPR. Broken ribs are uncomfortable but survivable. Every minute without compressions drops the chance of survival by roughly 7% to 10%. When you weigh a cracked rib against a dead patient, the math is not close.

Active Compression-Decompression and Other Techniques

Standard CPR is not the only technique that has been studied. Active compression-decompression (ACD) CPR uses a suction-cup device to actively pull the chest wall back up between compressions, aiming to improve blood return to the heart. The injury profile is different and, by some measures, worse. An autopsy study found rib fractures in 68% of patients treated with ACD-CPR alone, but when ACD-CPR was applied after a period of standard CPR, the rate climbed to 93%. Sternal fractures followed the same pattern. The study also flagged a higher risk of iatrogenic cardiac injury with the ACD technique.²⁶

Beyond skeletal injuries, rib fractures during CPR can produce secondary complications. The whole-body CT study found pneumothorax (collapsed lung) in 10% of cases, mediastinal hematoma in 13%, and hemothorax in 3%.¹ Research examining chest wall mechanics during mechanical CPR found that higher chest wall deformation velocity was associated with more fractures, suggesting that the speed of compression, not just the depth, plays a role in how the ribs break.²⁷ Understanding these mechanics may eventually help engineers design devices or feedback systems that minimize unnecessary bone damage while maintaining the compression quality needed to keep someone alive.

1
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2
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4
PubMed. Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers
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PubMed. Low bone mineral density increases the risk of multiple rib and sternal fractures during cardiopulmonary resuscitation
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Egyptian Journal of Forensic Sciences. Complications of cardiopulmonary resuscitation in non-traumatic cases and factors affecting complications
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PubMed Central. Computed tomographic findings of chest injuries following cardiopulmonary resuscitation: More complications for prolonged chest compressions?
8
PubMed Central. CPR related injuries of the chest wall: direct and indirect fractures
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11
PubMed. Safety of mechanical and manual chest compressions in cardiac arrest patients: A systematic review and meta-analysis
12
PubMed Central. Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study
13
PubMed Central. Rib fractures and other injuries after cardiopulmonary resuscitation for non-traumatic cardiac arrest: a systematic review and meta-analysis
14
PubMed. Does cardiopulmonary resuscitation cause rib fractures in children? A systematic review
15
PubMed. Increased incidence of CPR-related rib fractures in infants–is it related to changes in CPR technique?
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PubMed Central. Both Autopsy and Computed Tomography Are Necessary for Accurately Detecting Rib Fractures Due to Cardiopulmonary Resuscitation
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PubMed Central. Diagnostic accuracy of rib fracture detection in forensic post-mortem photon counting CT
22
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PubMed Central. Public Perceptions on Why Women Receive Less Bystander Cardiopulmonary Resuscitation Than Men in Out-of-Hospital Cardiac Arrest
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PubMed Central. Lay Bystanders’ Perspectives on What Facilitates Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Real Cardiac Arrests
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Resuscitation Plus. Chest wall mechanics during mechanical chest compression and its relationship to CPR-related injuries and survival