Cardiopulmonary resuscitation (CPR) is a crucial intervention in cases of cardiac arrest, significantly impacting patient survival rates. However, the administration of CPR, particularly chest compressions, can lead to various injuries, with rib and sternal fractures being common complications.
According to some studies, about 30% of cardiac arrest victims who receive CPR end up with a broken rib or sternum. However, other studies suggest that the frequency of rib fractures is higher, with one study reporting that 89% of autopsy patients who received CPR had fractured ribs. The frequency of rib fractures may also vary depending on who performs CPR and the duration of the procedure:
One study found that one in four patients who received CPR from a paramedic outside the hospital had rib fractures, compared to one in three patients who received CPR from a layperson. Another study found that nearly half of patients who received CPR from someone other than a physician in the hospital had rib fractures, compared to about one in three patients who received CPR from a doctor.
Studies have shown that chest compressions during CPR can result in rib fractures in approximately 79% of patients and sternal fractures in about 54% of cases (Saliba, 2024). Additionally, rib and sternal fractures are reported to be relatively common following conventional CPR, with at least one-third of resuscitated patients sustaining rib fractures and one-fifth sustaining sternum fractures (Huang & Kumar, 2013; Kralj et al., 2015). These injuries are not limited to the ribs and sternum; they can also involve severe thoracic vertebral spine injuries, pneumothorax, hemothorax, and even internal mammary artery injuries (Heidorn et al., 2022; Alar & Gedik, 2019; Tokioka et al., 2018; Morgan et al., 2019). The severity of these injuries underscores the importance of proper CPR technique and the need for healthcare providers to be aware of potential complications. While CPR is essential for saving lives during cardiac arrest, it is crucial to balance the life-saving benefits with the risk of injury. In cases where rib fractures occur, some patients may require surgical stabilization of rib fractures to manage the associated complications effectively (Prins et al., 2022).
Furthermore, accurate detection of rib fractures due to CPR may require a combination of autopsy and computed tomography to ensure proper diagnosis (Hamanaka et al., 2020). A significant question remains, as to, the physiological state of those patients who received fractures during CPR verses prior to CPR.
In conclusion, while CPR is a critical intervention in cardiac arrest situations, it is essential for healthcare providers to be mindful of the potential complications, such as rib and sternal fractures, that can arise from the administration of chest compressions. Proper training, technique, and awareness of these risks are vital in optimizing patient outcomes during resuscitation efforts. Additionally, the use of CPR feedback devices seem relevant and should be in use during cardiac arrest management.
References:
- Alar, T. and Gedik, İ. (2019). Things to keep in mind after cardiopulmonary resuscitation: bilateral severe and widespread subcutaneous emphysema together with unilateral pneumothorax. The European Research Journal, 5(1), 183-185.
https://doi.org/10.18621/eurj.396685
- Hamanaka, K., Nishiyama, K., Nakamura, M., Takaso, M., & Hitosugi, M. (2020). Both autopsy and computed tomography are necessary for accurately detecting rib fractures due to cardiopulmonary resuscitation. Diagnostics, 10(9), 697.
https://doi.org/10.3390/diagnostics10090697
- Heidorn, E., Cortes, V., & Ong, A. (2022). Severe thoracic vertebral spine injury as a complication of component of cardiopulmonary resuscitation. The American Surgeon, 88(5), 986-988.
https://doi.org/10.1177/00031348211058619
- Huang, Y. and Kumar, A. (2013). Classical skeletal injuries shown on 18f-fdg pet/ct following successful cardiopulmonary resuscitation. Clinical Nuclear Medicine, 38(5), 395-396.
https://doi.org/10.1097/rlu.0b013e3182817d2d
- Kralj, E., Podbregar, M., Kejžar, N., & Balažic, J. (2015). Frequency and number of resuscitation related rib and sternum fractures are higher than generally considered. Resuscitation, 93, 136-141.
https://doi.org/10.1016/j.resuscitation.2015.02.034
- Morgan, J., Bolanos, A., Al‐Balas, H., & Paniagua, D. (2019). Bilateral internal mammary artery laceration after cardiac pulmonary resuscitation. Catheterization and Cardiovascular Interventions, 93(7), 1298-1300.
https://doi.org/10.1002/ccd.28180
- Prins, J., Lieshout, E., Eriksson, E., Barnes, M., Blokhuis, T., Caragounis, E., … & Wijffels, M. (2022). Surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures following cardiopulmonary resuscitation: an international, retrospective matched case-control study. Journal of Trauma and Acute Care Surgery, 93(6), 727-735.
https://doi.org/10.1097/ta.0000000000003769
- Saliba, T. (2024). Thoracic vertebra chance fracture resulting from mechanical cpr. Journal of the Belgian Society of Radiology, 108(1).
https://doi.org/10.5334/jbsr.3564
- Tokioka, S., Masuda, S., Shirokawa, M., & Shibui, T. (2018). Internal mammary artery injury without chest wall fractures after cardiopulmonary resuscitation: a case report. Case Reports in Emergency Medicine, 2018, 1-3.