5 Common CPR Side Effects and Complications of CPR

CPR or Cardiopulmonary Resuscitation, is an emergency treatment used to restart a person's heart and breathing during cardiac emergencies. But just how effective is CPR? What are the CPR side effects and common CPR complications? And, if someone is lucky enough to survive a cardiopulmonary emergency, what does that mean for that person's long-term health? This article delves into the common side effects and complications associated with CPR, offering insights to help individuals understand and navigate the complexities of this life-preserving procedure.

CPR Complications

While there is an increased risk of CPR complications with deeper chest compressions, it is vital to realize that CPR-related injuries or CPR side effects were, by and large, not fatal. Some of the most common complications or CPR side effects of in and out of hospital Cardiopulmonary Resuscitation are the following:

  1. Aspiration & Vomiting: During CPR, the forceful chest compressions triggers vomiting in the person being resuscitated. 
  2. Broken Ribs: The application of force during CPR chest compressions leads to the cracking or fracturing of ribs, particularly in older individuals or those with fragile bones. 
  3. Internal Brain Injuries: CPR aims to maintain the oxygen supply to the brain, but it inadvertently cause injuries to the brain if not performed correctly. 
  4. Abdominal Distension: In some cases, the forceful chest compressions during CPR leads to abdominal distension, causing the abdomen to swell due to the accumulation of air or other substances in the digestive tract. 
  5. Aspiration Pneumonia: Aspiration pneumonia is a severe complication that results from inhaling vomit during CPR. 

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Aspiration & Vomiting

Vomiting during CPR is a frequently encountered complication and poses a significant risk to the cardiac arrest victim. When a person experiences cardiac arrest, they are unconscious and unable to clear any vomit that occurs. If the vomit is not promptly removed, it can be aspirated, meaning it is inhaled into the lungs. This has dire consequences as it obstructs the airway and leads to severe infections.

Aspiration pneumonia is a potential outcome of this scenario. When foreign material, such as stomach contents, enters the lungs, it creates an environment ripe for infection. Bacteria present in the stomach leads to a serious lung infection, exacerbating the already critical condition of the individual. Aspiration pneumonia further complicate the recovery process, emphasizing the critical importance of rapid and effective airway management during CPR to prevent such complications.


Broken Ribs and Skeletal Chest Injuries

Rib fractures are common skeletal injuries during CPR due to the forceful chest compressions necessary to maintain circulation. While these fractures are painful, they are generally considered acceptable to ensure vital circulation during cardiac arrest. Sternal fractures, though less frequent, also occur and emphasize the importance of proper technique and training among responders.

In rare cases, CPR leads to internal organ or vascular damage, highlighting the need for precise execution. Ultimately, the decision to perform CPR must balance potential risks with the urgency of the situation, with the paramount goal being to increase the victim's chances of survival by restoring circulation and oxygenation, outweighing potential complications.


Internal Brain Injuries

CPR, while crucial in maintaining blood circulation, still result in potential complications, particularly concerning the brain. During CPR, the brain receives approximately 5% less oxygen than usual, which, over time, increases the risk of brain damage. This risk becomes more significant the longer the heart remains stopped, with the window for brain damage often falling within 4 to 6 minutes after cardiac arrest. Such damage have profound and lasting effects on a person's health, potentially leading to long-term complications.


Abdominal Distension

Abdominal distension is another common side effect of CPR. As air is forcefully pushed into the lungs during chest compressions, it leads to the patient's abdomen becoming bloated and filled with air. This distension compresses the lungs, making it more challenging to ventilate effectively. Additionally, a bloated abdomen increases the risk of vomiting, further complicating the resuscitation process. Responders must be prepared to address these challenges promptly, balancing the need for effective ventilation with the potential for abdominal distension during CPR.


Aspiration Pneumonia

Aspiration pneumonia is a consequential complication of CPR resulting from the inhalation of vomit or foreign objects, such as teeth, into the lungs. This condition poses a threat to the health of a cardiac arrest patient and complicates their recovery, potentially even leading to fatal outcomes, despite surviving the initial CPR intervention.

In light of these potential CPR side effects, it becomes clear that surviving CPR does not guarantee an individual's long-term health and quality of life. The aftermath of CPR leaves lasting physical and psychological impacts. Beyond the physical complications, the psychological ramifications of a near-death experience is profound. Survivors grapples with stress, anxiety, depression, and other psychological disorders, further emphasizing the importance of comprehensive post-CPR care and support to address both the physical and emotional aspects of recovery.

What is CPR and How Does it Work?

Cardiopulmonary Resuscitation (CPR) is a life-saving technique designed to support the circulatory and respiratory systems of a person in distress. It manually circulates oxygen-rich blood throughout the body through chest compressions, effectively substituting the heart's pumping action.

Additionally, CPR includes rescue breaths, which deliver oxygen directly into the lungs, ensuring vital oxygenation when the person is not breathing or breathing inadequately. This approach safeguards vital organs, particularly the brain, from oxygen deprivation and aims to mitigate the risk of brain damage.

CPR is a bridge to professional medical assistance, buying precious time until emergency services arrive to address the underlying cause of the cardiac or respiratory arrest.


Contraindications of CPR

There are certain contraindications or situations where CPR is not recommended or appropriate. These contraindications include:

  • Decomposed or Clearly Irreversible Death: If a person is clearly deceased, such as in cases of advanced decomposition or rigor mortis, CPR is not effective, and it is not recommended.
  • Do-Not-Resuscitate (DNR) Orders: Some individuals have a legally documented Do-Not-Resuscitate (DNR) order, indicating their explicit wish not to receive CPR in the event of cardiac arrest. In such cases, healthcare providers should respect the person's wishes and not initiate CPR.
  • Rigor Mortis: Rigor mortis is the stiffening of muscles after death. When rigor mortis is present, it indicates that CPR is unlikely to be successful, and it may not be initiated.
  • Signs of Death: If there are clear signs of irreversible death, such as dependent lividity (blood pooling in the lowest parts of the body), rigor mortis, or decapitation, CPR is generally not appropriate.
  • Terminal Illness with Comfort Measures Only: In cases where a person is under hospice or palliative care with a focus on comfort measures only and not life-prolonging interventions, CPR is contraindicated based on the individual's wishes and the treatment plan.


What is HIBI?

Hypoxic–ischemic brain injury (HIBI) is the leading cause of death in patients who are comatose after resuscitation from cardiac arrest. Most deaths caused by HIBI result from the withdrawal of life-sustaining treatment following prognostication of a poor neurological outcome. A poor neurological outcome—death from a neurological cause, persistent vegetative state, or severe neurological disability—is predicted in these patients by assessing the severity of HIBI.


Does Cardiac Arrest Survivors get back to normal after CPR?

Unfortunately, most out-of-hospital cardiac arrest victims do not survive after the arrest. Those with complex medical problems are much less likely to recover fully. It is crucial that you know that patients are often critically unwell after CPR and needs more treatment in a coronary care or intensive care unit to recover. In addition, cardiac arrest survivors report cognitive impairment, restricted mobility, depression, and restricted societal participation after hospital discharge.

Many patients survive CPR but don’t return to their physical or mental health before CPR. As a result, some of them needs a lot of rehabilitation. However, some clinical studies found improved outcomes in patients associated with therapies. In other cases, some patients go into a coma from which they might not recover or suffer from brain damage.


Cardiac Arrest Statistics

According to the most recent statistical analysis by the American Heart Association, 88% of out-of-hospital cardiac arrests happen at home, where there are no doctors or nurses, which is why it is so important that everyone be skilled in providing CPR. CPR training programs are designed to educate participants about both the techniques and potential CPR complications.

The rescuer must continue the CPR until the victim has a return of spontaneous circulation or ROSC. The average bystander skilled in CPR triples a victim’s chance of surviving an out-of-hospital cardiopulmonary emergency. However, the chances of receiving CPR from a non-professional in an out-of-hospital cardiac arrest situation is only approximately 32%.

Furthermore, of those victims who receive CPR outside of a hospital, less than 8% survive. According to the National Institute of Health, approximately 15% of patients are resuscitated and survive discharge in a hospital setting. A number that has remained relatively stable over the past three decades.

So, a 15% chance of survival is not bad. But what really happens during CPR? Cardiopulmonary resuscitation is a harsh medical intervention with multiple side effects from receiving it. There are also mechanical chest compression devices that are as effective as properly executed manual compressions and minimizes the impact of performance error and fatigue.

  • In the elderly, rib fracture is significantly more common due to the brittleness and weakness of their bones.
  • Cardiac arrest survivors report cognitive impairment, restricted mobility, depression, and restricted societal participation after hospital discharge.
  • Neurological status is a major determinant of overall functional outcome.
  • Post–cardiac arrest care is a critical component of advanced life support.
  • Most deaths caused by HIBI result from the withdrawal of life-sustaining treatment following prognostication of a poor neurological outcome.
  • Prospective studies found improved outcomes in patients associated with therapies.

How long does the brain stay alive after the heart stops?

The brain survive for up to about six minutes after cardiac arrest. If CPR is performed within six minutes, the brain survives the lack of oxygen. After about six minutes without CPR, the brain begins to die.


What is the survival rate after CPR?

A review of CPR outcomes studies reported that an average of 15% of patients experiencing arrest survive until hospital discharge (3%-27%). Furthermore, this long-term success rate has remained stable for 30 years.


How long do sternum fractures take to heal?

Most sternal fractures heal on their own without splinting or any other treatment. However, complete recovery usually takes 8 to 12 weeks.


How long do you do CPR before calling time of death?

The decision to call time of death during CPR is made by healthcare professionals and depends on various factors, including the cause of the cardiac arrest and the person's response to CPR. There is no fixed time limit for CPR, and efforts continues for an extended period if there's a chance of reversing the underlying issue. However, if the cause is deemed irreversible, healthcare providers eventually decides to stop resuscitation efforts, considering the individual's overall condition and the likelihood of success. CPR should be initiated promptly in a cardiac arrest situation, and the decision to continue or stop is made by trained professionals following established guidelines.

How to avoid complications while performing CPR?

To avoid complications during CPR, it's crucial to follow proper training, which includes learning from reputable organizations like CPR Select. Before initiating CPR, assess the scene for safety hazards to ensure your own well-being. Use correct technique, maintaining proper compression depth and rate, as per the guidelines you've learned. Minimize interruptions in compressions to sustain blood flow, and if available, utilize an automated external defibrillator (AED) following its instructions meticulously.

Is there a risk of legal issues after performing CPR?

Yes, there is a risk of legal issues after performing CPR, though Good Samaritan laws generally provide protection for individuals providing assistance during emergencies. These laws vary by jurisdiction but are intended to encourage bystanders to help without fear of legal repercussions. However, it's vital to adhere to your training and operate within your scope of practice to minimize potential risks associated with legal liabilities.

Can CPR cause internal bleeding?

Yes, CPR potentially cause internal injuries, including bleeding, though such occurrences are relatively rare. The risk of internal bleeding is heightened if CPR is performed incorrectly or on individuals with underlying health conditions. Proper CPR training and adherence to the latest CPR guidelines helps minimize this risk.

How often do CPR complications occur?

CPR complications are relatively rare, especially when performed by trained individuals according to established guidelines. However, the risk of complications increases if CPR is performed incorrectly or by untrained responders. Despite the potential for complications, the benefits of CPR in saving lives far outweigh the risks.

Are there complications specific to CPR in children?

Yes, pediatric CPR presents unique challenges and risks due to anatomical differences and variations in physiology compared to adults. Children have smaller chests and different airway structures, which affects the effectiveness of CPR techniques. Therefore, it's essential for responders to receive specific training in pediatric CPR to minimize complications and optimize outcomes in this population.

What are the long-term effects of injuries caused by CPR?

The long-term effects of injuries caused by CPR varies, but they are relatively rare. In most cases, injuries such as rib fractures or chest wall trauma heal without significant long-term consequences. However, in rare instances, individuals experiences chronic pain or other complications related to CPR. Overall, the long-term effects of CPR-related injuries are uncommon and depend on factors such as the severity of the injury and the individual's health status.

What is the proper technique for safe CPR?

The proper technique for safe CPR involves a combination of chest compressions and rescue breaths (if trained to do so).

  • To perform chest compressions, place the heel of one hand on the center of the person's chest, interlock the fingers of your other hand on top.
  • Compress the chest to a depth of at least 2-2.4 inches for adults and 1/3 the depth of the chest for children.
  • Maintain a compression rate of 100 to 120 compressions per minute.
  • If trained to provide rescue breaths, ensure a tight seal over the person's mouth and nose and deliver two breaths after every 30 compressions.

Understanding the correct CPR steps helps minimize the risk of CPR complications during an emergency.

How has CPR technique evolved to reduce complications?

CPR techniques have evolved over time through research and clinical experience to improve outcomes and reduce complications. For example, guidelines have been updated to emphasize the importance of high-quality chest compressions, including proper compression depth and rate. The introduction of automated external defibrillators has also played a significant role in improving outcomes by allowing for early defibrillation in cases of cardiac arrest, which increases the chances of survival.

What are the psychological effects on a person after performing CPR, especially if complications occur?

Performing CPR, particularly in high-stress situations or if complications arise, have profound psychological effects on individuals. Responders  experiences feelings of anxiety, stress, or guilt, especially if the outcome is not favorable. It's essential for responders to seek support and debriefing to process their emotions and experiences effectively. Accessing resources such as counseling or peer support groups helps responders cope with the psychological impact of performing CPR. CPR training for healthcare professionals goes in-depth into the physiological reasons behind CPR complications.

What are the Risks Associated with CPR?

Movie scenes influence many people’s idea of CPR, where successful resuscitation always happens, and people recover swiftly. But, in reality, this isn’t consistently the case. The human brain may not supply enough blood flow if the heart isn’t beating properly. Also, some human brain damage still occurs even if the CPR successfully gets the heart beating again by performing the correct chest compression rate for adults. In addition, if severe coronary artery disease is present, it triggers ventricular fibrillation or abnormal heart rhythms. If you’re in a public area CPR and an automated external defibrillator helps.

On the other hand, if CPR is given and successful, the recovery of cardiac arrest survivors will depend on several things, such as what caused it and how healthy they were when the cardiac arrest happened. After successful resuscitation, some people will fully recover, but some will still be very unwell and need more treatment. That’s why post-cardiac arrest care is a critical component of advanced life support. Unfortunately, there are also cases where some patients will never get back to their health level before the arrest. In addition, CPR is much less likely to work if you have a long-term or chronic condition or a terminal illness.

Learning CPR is a life-saving skill, but finding the time and resources to attend a traditional CPR class is a challenge. Fortunately, many organizations now offer online CPR class free of charge, making it more accessible for people to learn the necessary skills from the comfort of their own homes.