Cardiopulmonary Resuscitation (CPR) is a time-sensitive procedure that uses chest compressions and rescue breaths to manually maintain blood flow and oxygen delivery when a person’s heart or breathing stops. This intervention is designed to bridge the gap until professional medical help arrives, significantly increasing the chance of survival from sudden cardiac arrest. While trying to save a life is encouraged, the fear of causing harm by performing CPR on someone who might not need it is a common anxiety for bystanders. Understanding the proper assessment and potential consequences is important for confident action in an emergency.
Identifying the Need for Intervention
CPR is strictly indicated for individuals who are unresponsive and not breathing normally. The first step in any emergency is to check for responsiveness by gently tapping the person and shouting a question like “Are you okay?”. If the person does not respond, the rescuer must check for normal breathing, which should take no more than ten seconds.
Normal breathing is characterized by regular, quiet, and effortless chest rise and fall. Gasping, noisy, or labored breathing, sometimes called agonal breathing, is not considered normal and should be treated as an absence of breathing. If a person is unresponsive and not breathing normally, the medical consensus is to immediately begin chest compressions, indicating a likely cardiac arrest. If the person is conscious, responding, or breathing normally, CPR is not necessary.
Potential Physical Consequences
Performing chest compressions on a person whose heart is still beating and is breathing normally introduces mechanical force onto a functioning circulatory and respiratory system. The most common physical consequences of CPR, even when correctly performed on someone in cardiac arrest, are rib fractures and sternum fractures. These injuries occur in a significant number of adult resuscitations, with rib fractures estimated to occur in about 30–60% of cases and sternal fractures in roughly 24%.
If compressions are applied to a person who does not require them, the pain and potential trauma would be immediate and unnecessary. The compressions can cause bruising, separation of the costal cartilage, or fractures that lead to substantial pain and recovery time. Internal injuries, such as bruising of the heart muscle or damage to the liver or spleen from incorrectly placed compressions, are rare but possible complications.
The rescue breath component of CPR also carries risks when performed on a person who is not in cardiac arrest. Forceful or excessive rescue breaths can lead to gastric inflation, where air enters the stomach instead of the lungs. This can cause the stomach to swell, increasing the risk of vomiting and subsequent aspiration, where stomach contents are inhaled into the lungs. Aspiration pneumonia is a serious complication that is introduced unnecessarily when the person is breathing on their own.
Legal Protections for Rescuers
A significant concern for bystanders is the legal liability for causing injury while attempting to help. Good Samaritan laws are in place across most jurisdictions to protect individuals who voluntarily provide emergency assistance in good faith. These laws are designed to encourage bystanders to act without fear of legal repercussions if their efforts, even if unsuccessful or causing minor injury, were reasonable under the circumstances.
Legal protection typically covers a lay person who acts without expectation of payment and does not act with gross negligence or willful misconduct. Making an honest mistake in assessing the need for CPR, such as starting compressions on someone who only temporarily fainted, is generally covered. However, the laws do not protect against extreme carelessness or deliberate harmful actions, like ignoring a clear refusal of help or causing injury far beyond a reasonable attempt at resuscitation.