Cardiopulmonary Resuscitation (CPR) combines chest compressions and rescue breathing to maintain blood flow and oxygen supply until professional medical help arrives. While CPR mechanics are consistent for all adults, anatomical variations can challenge proper technique. Large breast tissue, for instance, can obscure the correct hand placement landmark for chest compressions. This guide provides specific techniques to ensure safe and effective compressions when treating a woman with a larger chest.
Universal Initial Steps
Before starting chest compressions, the rescuer must ensure the scene is safe from any immediate hazards. Once safety is confirmed, check for responsiveness by gently tapping the person’s shoulder and shouting, “Are you okay?” If the person does not respond, immediately activate emergency medical services (EMS) by calling 911 or the local emergency number. If a second person is present, send them to retrieve an Automated External Defibrillator (AED).
The patient must lie flat on their back on a firm surface, such as the floor, to provide a stable base for compressions. The rescuer should quickly check for normal breathing and a pulse for no more than 10 seconds. The head-tilt/chin-lift maneuver can be used to open the airway and better assess breathing. If the person is not breathing or is only gasping, compressions must begin immediately.
Locating the Correct Compression Site
The goal of chest compressions is to apply force directly to the sternum (breastbone) to effectively compress the heart beneath it. The correct compression site is on the lower half of this bone, which runs down the center of the chest. In a woman with a large chest, the breast tissue often extends over the sternum, making it difficult to accurately locate the compression site. Placing the heel of the hand on soft tissue instead of the sternum reduces compression effectiveness and may cause injury.
To overcome this challenge, the rescuer must displace the breast tissue away from the center of the chest. This maneuver ensures the compression force is directed onto the sternum. The rescuer can use the heel of their hand or fingers to physically push or lift the breast tissue laterally (to the side). If a second bystander is available, they can assist in holding the tissue away, maintaining exposure of the sternum.
Once the tissue is moved aside, the rescuer must quickly locate the lower half of the sternum, the firm, bony structure in the midline. The compression site is typically found in the middle of the chest, between the nipples, but the bony landmark must be confirmed before proceeding. This ensures that compressions are delivered to the rigid structure necessary to compress the heart, rather than the surrounding soft tissue.
Executing Effective Compressions
With the sternum exposed, place the heel of one hand directly onto the identified compression site in the center of the chest. The second hand is placed on top of the first. Fingers should be interlaced or extended and lifted off the chest wall to prevent applying pressure to the ribs. Position your body so shoulders are directly over your hands, keeping elbows straight to use body weight for the compressions.
Displacing the breast tissue does not change the essential parameters for CPR. Compressions must be delivered hard and fast, at a rate of 100 to 120 per minute. The compression depth should be at least 2 inches (5 centimeters) but not exceed 2.4 inches (6 centimeters). After each compression, allow the chest to fully recoil, enabling the heart to refill with blood. Continue the cycle with 30 compressions followed by 2 rescue breaths (if trained), or continuous compressions, minimizing interruptions until EMS takes over.