Cardiopulmonary Resuscitation (CPR) is a technique designed to manually circulate blood and oxygen when a person’s heart and breathing have stopped. This emergency procedure involves forceful, rhythmic chest compressions intended to serve as an artificial heart pump. CPR keeps oxygenated blood flowing to the brain and other vital organs. The procedure is fundamentally a response to cardiac arrest, which is defined by the absence of a pulse and normal breathing. Understanding the specific conditions that require CPR ensures the right intervention is provided at the right time.
The Critical Assessment: When is CPR Necessary?
The decision to initiate chest compressions is based on a narrow set of criteria, confirming the person is in cardiac arrest. Current guidelines from organizations like the American Heart Association emphasize checking for responsiveness and breathing first. If a person is unresponsive and not breathing, or is only gasping, a rescuer should immediately suspect cardiac arrest.
A trained rescuer should quickly check for a pulse, typically in the carotid artery in the neck, for no more than 10 seconds. The presence of a definite pulse indicates the heart is still beating, meaning the person is not in cardiac arrest. CPR is only warranted if the person is unresponsive, has abnormal or absent breathing, and lacks a detectable pulse.
The purpose of chest compressions is to take over the function of a heart that has failed completely. Applying this forceful intervention to a heart that is already pumping blood conflicts with the body’s natural circulation. If a pulse is present, the heart is functioning and does not require mechanical assistance.
Immediate Physical Consequences of Misapplied CPR
Effective chest compressions require significant force, intended to push the breastbone down at least two inches in an adult to circulate blood. Applying this force unnecessarily to a person with a beating heart can cause severe physical consequences. The most common injuries are fractures of the ribs or the sternum.
Studies show that rib fractures occur in an estimated 30–60% of adults who receive CPR, and sternal fractures happen in about 24% of cases, even when correctly applied. Applying this trauma when the heart is still beating causes unnecessary pain and injury. The force can disrupt the body’s natural rhythm, potentially causing an abnormal heart rhythm.
Beyond skeletal damage, compressions can injure underlying soft tissues and organs. Misplaced or excessive force risks lacerating or contusing the heart muscle itself. Internal trauma to organs near the chest cavity, such as the liver or spleen, is also a risk if compressions are too low or too hard. Fractured ribs can also puncture a lung, leading to a collapsed lung (pneumothorax).
Beyond Physical Harm: Other Risks and Psychological Impact
Performing compressions on a person who is unconscious but has a pulse can inflict severe pain, particularly if the person is semi-conscious. This forceful intervention on a beating heart can be a deeply traumatic experience for the victim. It may lead to psychological distress and anxiety upon recovery.
The rescuer also faces significant psychological consequences if they realize they caused harm. Feelings of guilt, anxiety, and self-doubt are common in rescuers following an emergency, especially if the outcome is negative or if they caused injury. This emotional toll can be severe, in some cases leading to post-traumatic stress disorder related to the event.
Another serious risk is the opportunity cost of delayed appropriate medical care. Focusing on unnecessary chest compressions prevents the rescuer from performing other needed interventions. Unresponsiveness may be due to a stroke, drug overdose, or severe blood sugar imbalance. These conditions require different, immediate treatments that are delayed by the misapplication of CPR.
Actionable Steps: What to Do Instead of CPR (If a Pulse is Present)
If a person is unresponsive but has a pulse, the immediate priority is to activate the emergency response system by calling the local emergency number. This step ensures professional medical help is on the way, equipped with advanced life support equipment. The rescuer should then focus on maintaining the person’s breathing and monitoring their condition.
The most important physical intervention is securing a clear airway, often accomplished using the head-tilt, chin-lift maneuver to prevent the tongue from blocking the throat. If the person is breathing normally, they should be placed in the recovery position, provided there is no suspected head, neck, or spinal injury. This position helps prevent aspiration, where vomit or fluid is inhaled into the lungs.
Continuous monitoring is necessary until emergency medical services arrive, checking the person’s breathing and pulse every few minutes. If the pulse stops or breathing becomes absent, the rescuer must immediately begin CPR. Proper training ensures a quick and accurate assessment to determine the correct intervention: chest compressions, rescue breathing, or monitoring and positioning.