If proper CPR involves compressing the chest so much such that the ribcage might break - doesnt that breakage risks a bone puncturing the heart?
If proper CPR involves compressing the chest so much such that the ribcage might break - doesnt that breakage risks a bone puncturing the heart?
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?
I’ve had a few different First Aid courses and the instructors all have slightly different reasoning. One argument for compression only is potential for passing disease mouth to mouth, the newer courses tend to teach this because sometimes people that don’t feel comfortable doing rescue breaths will fail to do CPR at all. Another is that in cases where you’ve witnessed the event, the blood is already fairly well oxygenated and if medical help has a good response time the benefits of breaths are minimal. The first is more about compression only CPR being better than nothing, breaths are still advised where the rescuer feels comfortable doing so. The second is pretty situational.
So it depends on the setting and patient. Kids tend to have respiratory causes of cardiac arrest so the focus is more on airway management and positive pressure ventilation. Kids don’t generally code just out of nowhere like say a 90 year old might keel over. There’s usually a specific cause and if you can correct that cause they will rebound.
As for adults it’s about the setting. Outside of the hospital we should be teaching cpr only. Especially for lay people. It gets too complicated and they’re too stressed out to remember 30 and 2, 15 and 2. Plus most people have a reserve of air in their airway and lungs that gets circulated with compressions so focusing too much on trying to get breaths in causes too many delays and confusion.
Now for ems you can debate whether they should do cpr only with a non rebreather, a bls airway and bagging, a biad, or a definitive airway. It hugely depends on your protocols, provider availability, and who the patient is.
In hospital we are almost always going to secure the airway during a code to remove that from the equation. We have the resources and it can be done relatively quickly without the need to delay cpr for more than a pulse check in many cases.