Can I cause damage to the ribs if I perform the compressions? look what the studios bring us ...

A very common question that arises in the courses of cardiopulmonary resuscitation (CPR) is the following: Can I cause any harm to the victim when I perform the compressions?

First, tell them not to be afraid of breaking a rib or hurting it. After my professional experience in intensive care and coronary care unit, I had the opportunity to talk with cardiac arrest survivors and none of them ever said to me: «I wish I had not been resuscitated because my chest hurts». Analgesic for pain and keep living.

The goal of compressions is to keep the blood circulating and replace the function of the stopped heart. Therefore, if we do not perform chest compressions, oxygen will not reach the brain and the rest of the organs.

The victim will suffer brain damage IRREVERSIBLE from 5 minutes if we do not perform CPR.

It is important to review the thoracic anatomy a little before continuing, to differentiate the parts that, in this case, most interest us: the bone of the sternum, the costal cartilages and the ribs. The upper ribs are joined to the sternum on the front by means of thick, elastic and hard cartilages that are the costal cartilages.

The cartilages Sacks They are hyaline cartilage bars that serve to extend the ribs forward and contribute significantly to the elasticity of the walls of the chest, allowing the lungs to expand when breathing, without causing damage or breaking the bones. This explains why we can compress and decompress during cardiopulmonary resuscitation.

Now you know that the area where the compressions are made affects the center of the thorax (sternum) and on its sides we find the costal cartilages.

But to answer your question in a professional way and throw a little light on this issue I have turned to the medical literature:

In the literature, a meta-analysis of 27 studies showed that the incidence of pericardial injury after performing external cardiac compressions was 8,5%, the fracture of the sternum it was from 8,5% and rib fractures after resuscitation were the 26% [1] They also document a series of cases of myocardial lacerations and chamber ruptures and incidence of conduction system injuries. I have included the number of patients who received CPR only with their hands in both cases, discarding data on injuries associated with chest compression devices.

El-Banayosy [2] reported 113 patients on whom 20 minutes or more minutes of external compressions were performed, with a survival of 70% without any complication attributable to external compressions.

Conclusions:

The possibility of causing some damage after cardiac compressions exists, but it will depend on the quality of the cardiac compressions.

⁃ If we do not perform compressions after a cardiac arrest, IRREVERSIBLE brain damage will occur from 5 minutes.

The message: compress, compress and compress! Until the arrival of the semiautomatic defibrillator to follow your instructions or the emergency medical services (SEM).

BIBILIOGRAPHY:

1 Miller AC, Rosati SF, Suffredini AF, Schrump DS.A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries.Resuscitation. 2014 Jun; 85 (6): 724-31. doi: 10.1016 / j.resuscitation.2014.01.028. Epub 2014 Feb 10. Review PMID: 24525116

2 el-Banayosy A, Brehm C, Kizner L, Hartmann D, Körtke H, Körner MM, Minami K, Reichelt W, Körfer R. Cardiopulmonary resuscitation after cardiac surgery: a two-year study.J Cardiothorac Vasc Anesth. 1998 Aug; 12 (4): 390-2. PMID: 9713724

Matías Soria.

Training Department

ANEK S3.


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