Cardiopulmonary resuscitation (CPR) is a life-saving procedure designed for individuals experiencing cardiac arrest, where the heart has stopped beating. The technique combines rhythmic chest compressions and rescue breaths to manually circulate blood and oxygen to vital organs until professional medical help arrives. Because CPR involves forceful physical intervention, performing it on a person who is conscious, breathing, and has a pulse is unnecessary and can cause significant physical harm. The fundamental purpose of CPR is to bridge the gap between sudden death and advanced medical care, and it is strictly reserved for a medical emergency where the heart has ceased to function.
Immediate Physical Consequences of Applying CPR Unnecessarily
Applying the necessary force for effective chest compressions to a person whose heart is still beating results in severe trauma to the chest wall and internal structures. Compressions require pushing down on the center of the chest to a depth of about 2 to 2.4 inches (5 to 6 centimeters), a degree of force a conscious body cannot withstand. The most immediate and common injuries are rib fractures, which occur even during necessary resuscitation attempts on unconscious patients. Performing this action on a live person causes extreme pain and unnecessary damage.
The sternum, or breastbone, can also be fractured due to the direct downward pressure applied during compressions. These skeletal injuries can lead to complications like a flail chest, where a segment of the rib cage moves independently, compromising breathing. Even without a full fracture, the cartilage connecting the ribs to the sternum can separate, causing severe localized pain and instability. The force is intended to compress the heart between the sternum and the spine, a movement that is damaging when the heart is already pumping blood effectively.
Unnecessary chest compressions can also damage internal organs situated near the chest cavity. The heart and lungs can suffer contusions, which are bruises caused by the blunt force trauma. Excessive or misapplied force could potentially lead to more severe injuries, such as a lung puncture from a fractured rib. In extreme cases, lacerations of abdominal organs like the liver or spleen may occur if compressions are placed too low. Internal bleeding from injury to these vascular organs is a serious concern.
Rescue breathing, the second component of CPR, also carries risks when performed on a person breathing normally. Forcing air into the lungs can inadvertently push air into the stomach, causing gastric distention. This abdominal bloating pushes up on the diaphragm, making it harder for the person to breathe. A more serious consequence is the risk of vomiting followed by aspiration, where stomach contents are inhaled into the lungs, potentially causing aspiration pneumonia.
Determining the Need for CPR
Emergency response requires a quick and accurate assessment to determine if CPR is warranted. CPR is exclusively for a person who is unresponsive, not breathing normally, and has no pulse.
The initial assessment protocol begins by attempting to rouse the person, such as by tapping and shouting to establish unresponsiveness. If the person responds, they do not require CPR.
If there is no response, the next step is to check for normal breathing, which should take no more than 10 seconds. Agonal gasps—infrequent, noisy, or labored breaths—are not considered normal breathing and indicate a need for intervention. A conscious person is, by definition, breathing and circulating blood well enough to sustain brain function. Initiating compressions on a person who is conscious and breathing is a gross deviation from established procedures.
Trained rescuers check for a pulse simultaneously with checking for breathing, looking for a strong beat in the carotid artery. The absence of a pulse confirms cardiac arrest and the need for immediate CPR. If a person appears to have fainted or is sleeping, they will still have a pulse and be breathing normally, ruling out the need for resuscitation. The assessment process is designed to create a clear boundary between life-threatening cardiac arrest and other medical conditions.
Legal and Ethical Considerations
Intervening with CPR on a conscious person introduces significant legal and ethical complications because the procedure is highly invasive. Patients have the right to autonomy, meaning they must consent to medical treatment. Since a person in cardiac arrest is unconscious, consent is implied by the life-threatening nature of the emergency.
A conscious person is capable of expressing consent or refusal. Performing forceful chest compressions against their will, even with good intentions, can be legally construed as battery. Battery is defined as unconsented, unwanted physical contact. This legal issue is distinct from negligence, as the act itself is the source of the claim, not the quality of the care given.
Good Samaritan laws exist in many jurisdictions to protect lay rescuers from liability when they act in good faith during an emergency to save a life. These laws typically shield a rescuer from civil lawsuits alleging negligence that might arise from an unintentional injury, such as a broken rib during a necessary, life-saving resuscitation attempt. However, these protections are generally voided in cases of gross misconduct or willful, reckless behavior. Acting outside the scope of a genuine, life-threatening emergency, such as performing CPR on a conscious person, jeopardizes the legal protection these laws provide.