If proper CPR involves compressing the chest so much such that the ribcage might break - doesnt that breakage risks a bone puncturing the heart?
Yes, more common however is a rib puncturing a lung. Regardless, the (slim) possibility of that happening is preferable to the certain death that would happen if you didn’t perform CPR
So I’ve done lots of cpr. First off it’s kind of a misconception that you’ll break ribs from cpr. You are more likely to break cartilage than actually break bones and appropriate cpr isn’t going to break bones unless they’re the smallest most frail person and the individual doing cpr is going crazy doing compressions.
Even if you break ribs you’re probably not going to have a displaced rib fracture as there’s muscles and tissue holding those bones in place, it’s pretty rare to have ribs break so bad they risk puncturing organs and it usually involves catastrophic trauma, not what you get from cpr.
I have, thankfully, never done CPR live, but I’m certified to teach CPR by the Danish First Aid Council. So I have a interest in learning from actual practitioners, although I’m obviously not allowed to alter the course.
Where do you stand on ventilation? Currently I have to teach 30:2 mouth to mouth, but I know that there’s talk about skipping ventilation either entirely or at least for adults. The thinking being that children don’t suffer spontaneous cardiac arrests, but that it’s usually a result of blocked airways.
Do you do ventilation and does it make a difference in your experience?
CCR is the primary method taught in cardiac care. E.g only compression. This is because the primary issue is preventing clots and making sure you get some blood flow to the tissues. Full oxygenation isn’t as important due to lower oxygen demand of an unconscious person.
While we’re on the topic of CPR, I want to address the myth that CPR “almost never works”. It’s great at what it does, which is pumping blood through the body enough to keep vital organs supplied with a bare minimum of oxygen so they can survive.
However, there’s usually a reason why the heart has stopped beating and in most cases, CPR can’t reverse that reason. If the patient is in a car crash and has completely bled out, CPR won’t get any blood back into their system. Or if they’re at the end stage of a terminal disease, CPR can’t magically cure the disease.
But in cases where the cause for the cardiac arrest is simple and easily reversed, chances of survival are much higher. For example, if someone is drowning and you get them out of the water within a few minutes of cardiac arrest, CPR is very effective, with the majority of patients surviving. Here’s a study with 113 patients who were resuscitated after drowning and only 8 were confirmed dead. For 20 patients, the outcome was unknown, but even if they all died as well, that’s still a 75% survival rate.
It’s not that CPR doesn’t work, it’s that outcomes after resuscitation usually aren’t great. The study doesn’t disclose ages or neurological outcomes post-rescuscitation so that limits my interpretation but quick rescue and quick CPR is key in those acute, single reason emergencies. That isn’t to say in an emergency situation you shouldn’t try especially since you don’t know that person’s wishes. There are good outcomes but usually for underlying healthy people who had one thing go wrong. Think the athlete who’s heart stops on the field for some reason.
I’ve admitted at least a thousand people into a hospital through the ER and I tell everyone that it’s not like on TV. If you’re older, sick, multiple chronic diseases, don’t take care of yourself, etc. the chances of any kind of quality of life after CPR is limited. Death is terrifying and I understand them wanting to try but it’s just not realistic a lot of the time. We need better deaths in the US and more in-depth end-of-life conversations with our patients. That should be starting in the PCP’s office. Trying to discuss that with a patient in the ER who’s already scared isn’t ideal. I’ve seen patients with do not resuscitate/do not intubate orders on file change their mind when they’re suffocating and panicking then once they’re more stable immediately change their mind back.
