Have to give CPR? Breaking ribs may be better for heart attack patients in the long-run

SOPHIA ANTIPOLIS, France – Cardiopulmonary Resuscitation (CPR) significantly increases the chance of survival following a heart attack. However, not all CPR chest compressions are equally effective. According to a new study, deep chest compressions are more effective than shallow ones at preserving brain function, even if they do break bones.

In 2010 and again in 2015, CPR guidelines were updated to recommend deeper chest compressions. These updates however, create concerns regarding CPR-related injuries.

To examine the association between chest compression depth, CPR injuries, and health outcomes, researchers in Spain are looking at comatose heart attack survivors who typically undergo prolonged CPR attempts.

“We wanted to analyze the effect of deep chest compressions during prolonged resuscitation, when they could make a real difference to outcomes,” says Dr. Irene Marco Clement of Madrid’s University Hospital La Paz in a media release.

Short-term pain may improve long-term health

The study enrolls 510 heart attack survivors who had been admitted to a cardiac care unit between 2006 and 2020. Patients then fall into three groups: those admitted from 2006 to 2010, 2011 to 2015, and 2016 to 2020. This allows researchers to look at the effect of the recent CPR guideline updates.

The report by The European Society of Cardiology (ESC) finds higher rates of CPR-related injuries after 2010 (12.7% from 2006 to 2010, 23.5% from 2011 to 2015, and 22.7% from 2016 to 2020). Despite these injuries, they also reveal better brain function in these patient’s later years. Study authors find highest brain function in the 2016 to 2020 group.

Consistent with these findings, the data also shows patients with CPR-related injuries have better brain function. While 65.1 percent of patients with CPR injuries have high brain function, only 43.2 percent with no injuries have high brain function after their trauma.

“Survival and neurological outcome improved significantly during the 14-year study,” Clement adds. “Members of the public increasingly came to the rescue with CPR and there was greater use of AEDs. Injuries from CPR rose, but these patients were less likely to have brain damage.”

CPR doesn’t require mouth-to-mouth

In light of the COVID-19 pandemic and fears regarding virus transmission, Clement says chest compressions alone may be just as effective as conventional CPR with mouth-to-mouth breathing.

“Personal safety always comes first, and resuscitators should only do what they feel comfortable with,” Clement explains. “If you are concerned about possible contagion, you could omit mouth-to-mouth breaths: chest compressions alone may be as effective as conventional CPR.”

The study results are being presented at the ESC Congress 2020.

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