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06 August 2012

CPR often leads to broken ribs

A number of patients who receive cardiopulmonary resuscitation may end up with broken ribs or other bones as a result, according to researchers.

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A significant portion of patients 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 after receiving CPR, close to one third had at least one broken rib, while about 4% had a broken sternum.

What the study found

Duration of CPR and number of compressors were not contributing factors to trauma secondary to CPR.

There was, however, "a wide variation in the frequency of rib fractures from hospital to hospital (0-83.3%)," the researchers reported. "In high-risk hospitals (in which more than 50% of patients had rib fractures), the average age of the patients was higher, and non-physicians took part in ED CPR more often than they did at low-risk hospitals."

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.

"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 Dr Sayre, who was not involved in the new research.

How the study was done

For the new study, Dr Min Joung Kim from the Yonsei University College of Medicine in Seoul and colleagues performed computed tomography on 71 patients after successful prehospital or emergency department CPR.

Twenty-two had at least one broken rib and 14 had multiple breaks.

Only three patients had sternum fractures. Some had other injuries besides broken bones, such as blood in the chest wall or bruised lungs.

Women more likely to end up with fracture ribs

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 with out-of-hospital cardiac arrest, CPR by paramedics produced a 25% rib fracture rate and CPR by bystanders yielded rib fractures in a third of cases.

For in-hospital arrests, 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 because they are more likely to have osteoporosis, the researchers said in their report, published in Resuscitation.

Dr Kim and colleagues said, however, they're not sure why patients seemed to do better if a doctor did the compressions.

(Reuters Health, August 2012)

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