CPR often leads to broken ribs
NEW YORK (Reuters Health) - A significant portion of the people who receive cardiopulmonary resuscitation may end up with broken ribs or other bones as a result, according to Korean researchers, who also found that some types of patients could be at higher risk than others.
In a study of people admitted to Korean hospitals, close to one third of those resuscitated after having CPR ended up with at least one broken rib, while about four percent had a broken breast bone, or sternum.
Dr. Michael Sayre, a spokesperson for the American Heart Association and a professor at the University of Washington in Seattle, said broken ribs are to be expected when doing CPR and the worry of causing a break shouldn't deter people from helping someone in cardiac arrest.
"I've talked to survivors and I never had anyone tell me, ‘Gosh, I wish no one had done this because my chest hurts,'" said Sayre, who was not involved in the new research.
For the new study, researchers led by Dr. Min Joung Kim from the Yonsei University College of Medicine in Seoul, gave CT scans to patients brought to eight hospital emergency departments between January and June of 2011. All had successful CPR either before getting to the hospital or in the ED.
Of the 71 patients scanned, the researchers found that 22 had at least one broken rib and 14 had multiple breaks.
Only three patients had broken breast bones - a plate of cartilage that connects the ribs - and some had other injuries besides broken bones, such as blood in the chest wall or bruised lungs.
Overall, age didn't seem to be a factor determining who was most likely to suffer fractures, but women and people whose CPR was performed by someone other than a doctor were more likely to end up with broken ribs.
Among patients whose compressions were performed outside the hospital, for instance, one in four who got CPR from a paramedic had rib fractures compared to one in three whose CPR was done by a layperson.
Of the patients who got CPR in the hospital, about one in three who got compressions by a doctor had fractures, as did nearly half of those whose CPR was done by someone other than a physician.
In total, about a quarter of the men and close to half of the women in the study had rib fractures.
Women may be more likely to have broken ribs after CPR, the researchers write in the journal Resuscitation, because they are more likely to have the bone-thinning disease osteoporosis.
Kim and colleagues said, however, they're not sure why patients seemed to do better if a doctor did the compressions.
Dr. Rahul Sharma, medical director and associate chief of service of the Emergency Department at the NYU Langone Medical Center in New York, told Reuters Health that he couldn't explain those results, but they shouldn't stop people who aren't doctors from performing CPR.
"To me this paper doesn't really convince me that we should not do CPR and that it should not be done by anyone other than a physician," said Sharma, who was not involved with the study.
Current CPR recommendations in both Europe and the U.S. call for chest compressions to be at least five centimeters (about two inches) deep, at a rate of 100 per minute or faster.
"The message has to be don't be afraid, don't worry, because any injuries that are caused are almost always minor," said Sayre.
Sharma added, "In the end, you saved that person's life. If you didn't do those compressions, that person wouldn't be alive."
SOURCE: Resuscitation, online July 23, 2012.
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