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Should You Break Ribs When Doing CPR?

It’s one thing to become certified in CPR. It’s an entirely different thing to actually apply those skills to a real-life situation.

One of the biggest concerns that come with performing CPR for the first time on an actual person is whether or not you will accidentally cause physical harm to their body.

After all, you are applying a good deal of pressure to the rib area while performing the necessary chest compressions.

What if while doing so you hear a telltale crack in the process?

The reality is, injury during CPR isn’t all that uncommon.

In fact, a significant portion of those who receive cardiopulmonary resuscitation end up with broken ribs or other bones as a result.

In other words, it’s sort of par for the course.

Because of this risk, many students learning CPR are hesitant to actually carry it out.

Some simply lack confidence while others are genuinely concerned over the possibility of breaking the patient’s ribs by doing so.

If you’re currently struggling and feeling a bit intimidated by the risks associated with performing CPR, this article may be of help to you.

Exactly how common are broken ribs during CPR?

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In order for CPR to be effective (in adult patients), chest compressions need to be performed at a depth of approximately 2 inches.

Any more shallow than that and the blood will not be moved around the body sufficiently.

Compressing the human chest by that much, however, requires a significant amount of force – up to about sixty pounds.

Given this amount of force, it’s easy to understand how and why ribs may break in the process of performing CPR.

The general consensus has held that approximately 30% of patients receiving CPR suffer rib fractures or breaks.

However, according to a 2015 study published in Resuscitation, those numbers may actually be considerably higher.

The study analyzed autopsy data from more than 2,000 patients who had received CPR for cardiac arrest not caused by trauma. What they found was that:

  • 86% of men and 91% of women presented with skeletal chest injuries
  • 59% of those men and 79% of those women had fractures of the sternum
  • 77% of those men and 85% of those women had fractures of the ribs
  • 33% of those men and 12% of those women had sternocostal separation

As you can see, a significant portion of patients studied had suffered from some type of breakage or fracture as a result of receiving CPR.

So, chances are pretty high that if and when you do perform resuscitation on a patient, some type of injury may occur as a result.

Who is most at risk of breaking or fracturing a bone during CPR?

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The data provided from the above referenced study makes it clear that of the two genders, women are more likely than men to experience chest injuries during CPR.

Additionally, the study also found that older patients tend to be more at risk of CPR-related injury than those who are younger.

Furthermore, the presence of certain existing health conditions, such as osteoporosis, which causes a weakening of the bones, can also increase the risk of skeletal injury.

Conversely, patients who are physical large – particularly those who are obese – are much less likely to suffer broken bones due to CPR than those with smaller frames.

Another study performed in Korea revealed that patients receiving CPR from a bystander are more likely to suffer chest injuries than individuals who receive CPR from a trained professional, such as a doctor or a paramedic.

So, the good news is, if you are properly educated on how to correctly deliver effective chest compressions, your risk of injuring someone in the process may be lower.

Risk of injury also goes up based on the size and strength of the individual performing CPR as well.

Generally speaking, men tend to cause more rib fractures and breaks due to the fact that they tend to have more upper body strength than women. Of course, this is not always the case.

What should you do if you hear (or feel) a bone crack?

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In the event that a person on whom you are performing CPR does experience a broken or fractured bone, you may hear a cracking sound.

At the very least, you’ll probably feel something crack or give way under your hands.

This is not always indicative of an actual break, however.

In fact, the initial sound or feeling of cracking can often be attributed to the cartilage in the ribs or sternum breaking, as opposed to the ribs themselves.

In any case, it’s not advisable to stop performing CPR even if you hear a cracking sound or think you feel a rib break.

While it’s certainly true that broken bones can be painful and may extend a person’s recovery time, ceasing resuscitation efforts could result in far worse – death in particular.

It is incredibly unlikely that someone who survived as a result of CPR would be upset after the fact over a broken bone.

Instead, they will probably be grateful to be alive, thanks to the resuscitator’s quick and proper response.

Don’t let fear stand in your way.

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The bottom line is, you should never allow fear of breaking someone’s ribs or causing other injuries stand in the way of life-saving efforts.

Broken bones heal, but death is forever.

Furthermore, most states have Good Samaritan laws in place that protect people who deliver CPR in good faith.

That means even in the unlikely event that someone were to try and sue, you would be protected.

The fact is, CPR is a vigorous and sometimes brutal procedure.

As such, there will always be a risk that the person on the receiving end becomes injured in the process.

However, if the person you assist is lucky enough to survive his or her ordeal, you can expect a heartfelt thank you – broken ribs and all.

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