Performing cardiopulmonary resuscitation (CPR) on an adult in cardiac arrest is a high-stress, physically demanding intervention necessary to sustain life until professional help arrives. Prompt initiation of chest compressions is vital because the risk of death from cardiac arrest is immediate. While the goal is to restore circulation, the significant force needed often results in physical injury, most commonly broken ribs, which is a recognized complication of effective resuscitation. This complication is far outweighed by the alternative of certain death without intervention.
The Critical Immediate Response
If you are performing chest compressions and feel or hear a cracking sensation, your immediate response must be to maintain compressions without hesitation. That sound or feeling suggests you are applying sufficient force to move the chest wall, which is necessary for effective CPR. Interrupting resuscitation to assess a potential injury significantly decreases the patient’s chance of survival because it stops the flow of oxygenated blood to the brain and heart.
You should continue to push hard and fast at the recommended rate of 100 to 120 compressions per minute, ensuring the proper adult depth of at least two inches. Quickly check your hand placement to confirm you are still compressing over the center of the breastbone, or sternum. A slight adjustment of your hand position may help avoid further localized injury while maintaining effective compressions. The priority is circulating blood, and a broken rib is a manageable injury compared to the consequence of stopping CPR.
Why Compressions Require Significant Force
Effective CPR requires the rescuer to compress the chest deeply enough to physically squeeze the heart between the sternum and the spine, pushing blood out to the body. Current guidelines for adults specify a compression depth of at least two inches, but not more than 2.4 inches. Achieving this depth means overcoming the natural rigidity of the adult rib cage and sternum.
To reach the required depth, a rescuer may need to apply a force of up to 50 kilograms (about 110 pounds), especially on a patient with a stiffer chest wall. This necessary force, coupled with the anatomical structure of the thorax, creates a risk of fracturing the sternum or ribs. The chest must also be allowed to fully recoil between each compression, which allows the heart to refill with blood. The likelihood of rib fractures is higher in elderly patients or those with pre-existing conditions like osteoporosis due to more fragile bones.
Other Potential Injuries During Resuscitation
Rib fractures are the most common complication of chest compressions, but they are not the only potential injury. The sternum, the long flat bone in the center of the chest, can also fracture during CPR. These skeletal injuries are a direct result of the pressure required to perform effective compressions.
More serious, though less frequent, complications can involve internal organs, such as lung contusions, or, rarely, lacerations of the liver or spleen. These internal injuries are uncommon when the rescuer maintains the proper hand position over the lower half of the sternum. Other complications include aspiration pneumonia from vomiting, a common side effect of cardiac arrest and CPR, or soft tissue damage like bruising on the chest. Despite these risks, the occurrence of serious internal injury remains a secondary concern to the immediate need for circulation.
Post-Resuscitation Reporting and Care
Once emergency medical services (EMS) personnel arrive and take over care, or the patient is transferred to a medical facility, you must communicate any known or suspected injuries. Reporting the sensation or sound of a fracture to the medical team is crucial for the patient’s subsequent medical evaluation and treatment plan.
The medical staff will use this information to determine the need for diagnostic imaging, such as X-rays, to assess the extent of the damage. Healthcare providers are trained to expect and manage these resuscitation-related injuries. The patient will receive appropriate care for fractured ribs or any other complications once the immediate life threat of cardiac arrest has been resolved.