21.07.23 12:13 PM Comment(s)

Frequently asked and frequently misunderstood, but does CPR (Cardiopulmonary Resuscitation) break ribs? In short: yes and no.

During CPR training we often get asked this exact question. CPR training is done in our first aid courses (including first aid level 1level 2 and level 3), and in greater detail in our Basic Life Support for Healthcare Professionals (BLS) Course.

Being able to perform CPR enables you to provide basic life support to a person experiencing sudden cardiac arrest. It provides you with the knowledge and skills to save someone’s life – which is a powerful tool to have. A quick tip: when giving chest compressions, make use of other bystanders too. Should you get tired, switch out with a bystander by showing them how to perform chest compressions, and ensuring that when they begin, they are doing them correctly. In this way you are educating fellow individuals should they be in such a situation again, alongside ensuring that the casualty is receiving adequate chest compressions, at the appropriate depth, consistently.

But will I break ribs giving CPR?

You will hear and feel various noises and movement while performing CPR, however this is not necessarily the sound of ribs breaking. This sound is most likely the cartilage connecting the breastbone to the ribs cracking slightly. The depth one needs to press at on someone’s chest when performing the CPR procedure is a lot deeper than what you would expect. CPR therefore takes a lot of force in order to ensure that you move the blood around the body successfully. For this reason, CPR should not be done on an individual that is conscious/breathing.

Broken ribs are a possibility, not a likelihood. Should a rib break, do not let it hinder your chest compressions. A cracked sternum or a broken rib could take around 4-6 weeks to heal. In saying this, a rib or sternum can heal, an untreated heart seeking compressions cannot.

Although usually the cartilage only cracks, the likelihood of ribs breaking is not insignificant. The most prominent possible reasons for ribs breaking include incorrect hand placement by the CPR provider or the age/medical history of the casualty.

Incorrect Hand Placement

As taught in CPR classes, your hands should be placed in the centre of the sternum. Should your hands be placed too far left or right of the sternum, the risk for breaking ribs runs higher. This is largely because of the depth at which CPR is provided. If the individual providing CPR does not have CPR certification or has not been shown the correct manner in which to perform CPR, this individual has a higher chance of breaking ribs.

Age/Medical History of the Patient

As bones age, they become more brittle and therefore, fragile. In situations with older casualties, the risk of breaking ribs is significantly higher, and the placement of the CPR providers hands is not the main reason behind possible broken ribs.

Alongside age, varying bone diseases (including osteoporosis) could increase the risk of broken ribs. Any illness that affects bone density or bone fragility increases the risk of breaking ribs significantly. Weaker bones are significantly more susceptible to breaking (understandably).

Infant CPR

Children’s bones (until the age of 10) are a lot more flexible. In this, their bones are more supple and can therefore move more when pressure is applied to them. Breaking children’s ribs while performing CPR can cause life threatening damages. For this reason, rather than using two palms while performing CPR on a child, only one hand is used. When performing CPR on a baby, two fingers are used at the centre of the chest.

In summary, ribs can break during CPR, however it is not guaranteed. Do not let the possibility of breaking ribs hinder you from performing CPR or alter the depth at which you perform CPR. Breaking ribs is not a sign of “effective CPR”! Breaking a rib is a small price to pay when considering an individual’s life could be saved.

When to Stop CPR

Should a rib break while performing CPR, this is not an indication to stop. The only time to stop chest compressions is when a medical professional arrives at the scene. As an individual you can stop/pause chest compressions when you are switching out with another person to perform the compressions. However, once you have started the compressions, they should not be stopped until a medical practitioner arrives on the scene and takes over.

In first aid the most important thing to remember is: Life Over Limb. Stopping CPR is likely to cause death, however breaking a rib will cause pain or skeletal injuries, but those are likely fixable.