Cardiopulmonary Resuscitation (CPR) is an emergency procedure designed to manually maintain blood circulation and oxygenation when a person’s heart has stopped. This intervention acts as a temporary pump, moving oxygen-rich blood to the brain and vital organs until advanced medical help arrives. The effectiveness of CPR is directly linked to the quality of its execution. Improper technique can render the procedure nearly useless, failing to generate necessary blood flow, and may also cause significant physical harm.
Failure to Achieve Life-Sustaining Circulation
The fundamental purpose of chest compressions is to generate a pressure gradient that forces blood out of the chest and toward the rest of the body. When CPR is performed incorrectly, the body’s tissues are starved of oxygen, quickly leading to cell death. The brain is particularly susceptible to this oxygen deprivation; damage begins after four minutes and becomes irreversible after about seven minutes without adequate blood flow.
Insufficient compression depth is a common error that prevents the heart from being adequately squeezed, failing to move oxygenated blood effectively. Guidelines recommend a compression depth of 5 to 6 centimeters in adults for proper circulation. Compressions that are too shallow do not create enough internal pressure to achieve adequate tissue perfusion, making the rescue attempt functionally equivalent to no CPR.
The rate of compressions also plays a significant role. Compressing too slowly (below 100 to 120 per minute) will not move enough blood to meet oxygen demands. Conversely, compressing too quickly (above 120 per minute) hinders effectiveness by not allowing the heart to fully refill between compressions. An improper rate or depth severely reduces the person’s chances of survival and recovery.
Physical Trauma from Improper Compressions
The mechanical force required to perform effective chest compressions carries an inherent risk of injury, but incorrect technique dramatically elevates this risk. Rib fractures are the most common injury, occurring in 30% to 60% of adults who receive CPR. These fractures are more likely with excessive force or improper hand placement.
Sternal fractures, or breaks in the breastbone, occur in nearly a quarter of adult recipients and relate directly to the concentrated pressure applied during compressions. Placing the hands too high or too low increases the chance of these skeletal injuries. Not allowing the chest to fully recoil between compressions also increases pressure within the chest cavity, which can worsen the risk of injury.
Incorrect hand placement can transfer force to the upper abdomen, resulting in damage to internal organs. Though rare, internal injuries like lacerations of the liver or spleen have been reported. While these injuries are serious, proper technique is necessary to minimize unnecessary harm.
Complications Related to Airway Management
Improper technique during rescue breaths introduces complications related to airway management. The most significant issue is gastric inflation, which happens when air is blown into the stomach instead of the lungs. This occurs if breaths are delivered too forcefully, too quickly, or if the rescuer fails to properly open the airway with the head tilt/chin lift maneuver.
Air accumulating in the stomach causes abdominal distension. The distended stomach pushes upward on the diaphragm, restricting the space for the lungs to expand and making subsequent ventilation attempts less effective. This stomach inflation also increases the risk of the person vomiting.
Vomiting during CPR is a serious event because the person is unconscious and lacks the reflex to protect their airway. This creates a high risk of aspiration, where stomach contents are inhaled into the lungs, potentially leading to aspiration pneumonia. If gastric distension occurs, a rescuer should adjust their technique to provide gentler breaths, ensuring the air goes into the lungs.