CPR often leads to broken ribs
By Andrew M. Seaman NEW YORK | Fri Aug 3, 2012 4:02pm EDT
http://www.reuters.com/article/2012/08/03/us-cpr-often-leads-to-broken-ribs-idUSBRE8721IF20120803

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.

HIGH-RISK GROUPS

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."