Cardiopulmonary Resuscitation (CPR) is a life-saving procedure performed when a person’s heart or breathing stops. It involves manually compressing the chest to circulate oxygenated blood to the brain and other organs until professional help arrives. CPR is a high-force physical maneuver, and the necessity of applying significant force means that complications are a common, though generally acceptable, consequence of attempting to save a life.
Identifying the Most Common Physical Injury
The most common physical injuries resulting from CPR are fractures to the ribs and the sternum, which is the breastbone. These musculoskeletal injuries are highly prevalent in adult resuscitation attempts, a direct result of the force required to effectively compress the chest cavity. Studies frequently report that rib fractures occur in a wide range of cases, often affecting between 30% and 80% of adult patients following CPR. The incidence of sternal fractures is also common, though typically lower than rib fractures, with rates around 25% or more in various populations.
The likelihood of sustaining these fractures increases significantly with advanced age, particularly in individuals with conditions like osteoporosis or reduced chest wall elasticity. For instance, the elderly population often experiences a much higher rate of skeletal injury due to lower bone density. Despite their frequency, these fractures are often minor and are a necessary trade-off for the chance of survival from cardiac arrest. Correct hand placement during compressions, on the lower half of the sternum, aims to maximize effectiveness while minimizing the risk of more serious internal injury.
The Mechanics Behind These Injuries
The reason for the high incidence of skeletal trauma lies in the mechanical requirements for effective chest compressions. Current guidelines from organizations like the American Heart Association (AHA) mandate that chest compressions must achieve a specific depth to circulate blood effectively. For an adult, this depth is at least 2 inches, but not exceeding 2.4 inches, or 5 to 6 centimeters.
Achieving this compression depth requires a substantial amount of force to overcome the natural stiffness of the chest wall. Rescuers must also maintain a rapid compression rate of 100 to 120 compressions per minute, which is physically demanding and repetitive. This combination of deep, rapid, and sustained force on the sternum and ribs is what causes the fractures.
Less Frequent but Severe Complications
While bone fractures are the most common complication, other injuries, though less frequent, can be clinically more severe. One significant concern is internal visceral injury, specifically lacerations to abdominal organs such as the liver or spleen. This type of damage typically occurs if the rescuer’s hands are placed too low on the chest, inadvertently applying pressure to the upper abdomen.
Pulmonary complications are also recognized, including pneumothorax, which is a collapsed lung, and hemothorax, which is blood accumulating in the chest cavity. These conditions can result from fractured ribs puncturing the lung tissue. Another complication is aspiration, where the contents of the stomach are regurgitated and inhaled into the lungs, which can lead to aspiration pneumonia. While these severe complications require immediate medical intervention, they are statistically much less common than simple rib or sternal fractures.