Should CPR Break Ribs?
Short answer
CPR can sometimes break ribs, and this is a normal and accepted risk during the procedure. The chest compressions need to be firm and deep enough to circulate blood, which may cause rib fractures, especially in older adults or people with fragile bones. Breaking ribs during CPR does not mean it was done incorrectly—it often means it was effective.
What Is CPR and Why Is It Performed?
Cardiopulmonary resuscitation (CPR) is an emergency procedure used when a person’s heart stops beating or they stop breathing. The purpose of CPR is to manually keep blood and oxygen circulating to critical organs like the brain and heart until professional medical help arrives or the heart restarts. CPR involves chest compressions—pushing hard and fast on the center of the chest—and sometimes rescue breaths.
Imagine you are a bystander witnessing someone suddenly collapse and become unresponsive. You check if they are breathing or moving, and they are not. This situation calls for immediate CPR. The procedure aims to mimic the heart’s pumping action by compressing the chest approximately two inches deep at a rate of 100 to 120 compressions per minute. This keeps oxygen-rich blood flowing, buying time for the person’s survival.
CPR is essential because the brain can suffer permanent damage if deprived of oxygen for more than a few minutes. Starting CPR quickly can prevent brain injury and save a life. Even if you are unsure or untrained, calling emergency services and beginning chest compressions can make a critical difference.
How Does CPR Work? A Step-by-Step Example
To see how CPR works, consider a hypothetical scenario: You are at home with a family member who suddenly collapses. You check their responsiveness by gently tapping and calling their name—no response. You look for normal breathing and see none. You immediately call 911 and begin CPR.
How to Perform CPR:
- Position your hands: Place the heel of one hand in the center of the chest, over the sternum (breastbone). Place the other hand on top, interlocking your fingers.
- Body position: Keep your arms straight and use your upper body weight as you press down.
- Compression depth and rate: Push hard and fast, compressing the chest approximately two inches deep at a steady rate of 100 to 120 compressions per minute. This means about two compressions per second.
- Allow full recoil: After each compression, let the chest rise completely before pushing down again. This helps the heart refill with blood.
- Rescue breaths: If trained and confident, give two rescue breaths after every 30 compressions by tilting the person’s head back, lifting the chin, pinching the nose shut, and breathing into their mouth until the chest rises.
The pressure you apply during compressions can sometimes cause ribs to crack or break. This is because the force used must be strong enough to compress the heart between the breastbone and spine. For example, if you press two inches deep at 100 compressions per minute, the ribs may fracture, but the blood flow needed to sustain life is restored.
Why Do Ribs Sometimes Break During CPR?
Rib fractures during CPR happen because the chest compressions require significant force. The sternum must be pushed down deeply enough to pump blood, pressing on the ribcage, which may crack or break ribs—especially in older adults, people with osteoporosis, or those with fragile bones.
The ribs serve as a protective cage for the heart and lungs, but they are not designed to withstand repeated deep compressions. When compressions are done correctly, the risk of rib fractures increases, but this risk is outweighed by the need to keep the heart pumping.
It's important to know that broken ribs do not indicate poor CPR technique. In fact, compressions that are too shallow or slow may fail to circulate blood effectively. Medical guidelines emphasize pressing hard and fast despite this risk.
Is It Normal to Break Ribs During CPR?
Yes, breaking ribs during CPR is common and expected. Medical professionals report that rib fractures occur frequently during CPR, especially in adults over 40 or in people with pre-existing bone conditions. The exact likelihood varies, but rib injury is a known side effect of effective chest compressions.
From a practical standpoint, if you are performing CPR and ribs break, do not stop compressions out of fear of injury. The priority is restoring blood flow. After the person regains consciousness, broken ribs may cause pain or discomfort, but this is a secondary concern in an emergency.
Knowing this helps reduce hesitation to start CPR. The risk of rib injury should never prevent a bystander from attempting to save a life.
What Are Some Terms People Often Confuse with CPR?
Understanding related terms can help clarify when CPR is appropriate and how it differs from other emergency techniques:
- Chest Compressions Only CPR: Sometimes called hands-only CPR, this method involves only chest compressions without rescue breaths. It is recommended for untrained rescuers or if giving breaths is uncomfortable.
- Heimlich Maneuver: This is a series of abdominal thrusts performed to clear airway blockages in choking victims. It is a different emergency procedure, not CPR.
- Defibrillation: This involves using an automated external defibrillator (AED) to deliver an electric shock to the heart to restore normal rhythm. AEDs are often used alongside CPR.
- Heart Attack: A heart attack occurs when blood flow to part of the heart muscle is blocked. CPR is performed only if the heart stops beating or the person becomes unresponsive and not breathing.
Knowing these distinctions helps ensure CPR is used correctly in emergencies.
How Can You Perform CPR Safely and Effectively?
If you need to perform CPR, follow these practical steps:
- Call for help: Dial emergency services before starting CPR or have someone else do it.
- Hand placement: Place your hands correctly on the center of the chest to avoid unnecessary injury.
- Compression technique: Use your body weight to push straight down, aiming for about two inches deep in adults.
- Compression rate: Maintain a steady pace of 100 to 120 compressions per minute. You can count “one and two and three and four” to keep rhythm.
- Avoid interruptions: Minimize pausing compressions to improve blood flow.
- When trained, add rescue breaths: If comfortable and trained, give two breaths after every 30 compressions.
- Use an AED if available: Follow device prompts immediately.
If you are unwilling or unable to give rescue breaths, hands-only CPR is still highly beneficial. Remember, effective compressions save lives even if ribs break.
What Should You Do After Performing CPR?
Once professional help arrives or the person regains consciousness, medical evaluation is essential. Broken ribs may cause pain or difficulty breathing and should be checked by a healthcare provider.
If the person is awake and alert:
- Help them sit or lie comfortably.
- Watch for signs of complications such as sharp chest pain, difficulty breathing, or coughing up blood.
- Encourage the person to seek medical care promptly.
If no medical personnel are immediately available, call a healthcare provider or go to the emergency room to assess for rib fractures or other injuries.
For the rescuer, performing CPR can be physically and emotionally challenging. It’s normal to feel stressed or shaken afterward. Support from friends, family, or counseling services can help process the experience.
What If CPR Is Done Incorrectly?
Incorrect CPR can reduce the chance of survival but rarely causes serious harm if done with good intentions. Common mistakes include:
- Compressions that are too shallow or slow, which do not circulate enough blood.
- Placing hands too low or too high on the chest, which can harm organs.
- Pausing too frequently during compressions.
- Giving breaths without proper head positioning, which can cause airway blockage.
Despite these issues, even imperfect CPR is better than no CPR. If ribs break, it usually means compressions were forceful enough to circulate blood effectively.
To improve CPR skills, consider taking a certified course where you can practice hands-on and receive feedback.
Frequently asked questions
Is it true that CPR always breaks ribs?
No, CPR does not always break ribs, but rib fractures are common because of the force needed. Whether ribs break depends on factors like age, bone strength, and compression technique.
Can I do CPR on myself if I'm alone?
Self-CPR is very difficult but possible in some cases by pressing your chest against a firm surface and pushing hard. However, calling emergency services immediately is crucial.
Does CPR cause permanent damage besides broken ribs?
CPR’s main risk is broken ribs, but serious injury is rare. The benefits of saving a life far outweigh the risk of injury.
How do I know if CPR is working?
You may see signs like the person gasping, moving, coughing, or beginning to breathe normally. Effective compressions usually restore some pulse and circulation but always continue until help arrives.
What if I’m afraid of hurting someone performing CPR?
Fear of injury is common but should not stop you. CPR can save lives, and rib injuries are an acceptable risk. Doing nothing has a much higher risk of death.