Cardiac arrest: Better to break ribs than do nothing
There are only three things you can do wrong in a cardiac arrest. 1. Do nothing at all, 2. Place the victim in the recovery position, and 3. Not press hard enough during CPR. The best approach is to practice regularly in a first aid refresher course. / © Getty Images/Seksan Mongkhonkhamsao
Everyone should take a first aid course and ideally repeat it regularly. But even those who aren't feeling completely well shouldn't stand around idly if someone suffers cardiac arrest. Professor Dr. Bernd Böttiger is a federal medical officer of the German Red Cross (DRK) and chairman of the German Resuscitation Council. He calls for first aid to be made mandatory in schools throughout Germany. On World First Aid Day on September 13, he explains how chest compressions work and the three mistakes to avoid in emergencies.
How important are first aiders or laypeople when cardiac arrest occurs?
Bernd Böttiger: Your rapid intervention is literally life-saving. Many people don't know that in the case of cardiac arrest, you can't wait until the emergency services arrive. That would be a death sentence for the affected person. When the heart stops beating, no blood, and therefore no oxygen, reaches the brain. The brain, with its highly developed nerve cells, consumes around 20 percent of the oxygen, even though it only accounts for one to two percent of body weight. If the heart stops beating, the brain dies within three to five minutes. In this country, emergency services arrive on the scene within a median of nine minutes.
This is where first responders come in: Their job is to bridge the time by taking over the heart's pumping function from the outside – with cardiac massage.
As a first responder, how do I recognize a cardiac arrest – and what should I do if I need to?
Böttiger: Many people still remember the image of Danish soccer player Christian Eriksen, who collapsed during a European Championship match in 2021. He was lucky that it happened in an environment where many people knew how to perform CPR. And that's why he's still a professional soccer player today. Most such emergencies (an estimated 70 percent) occur at home. Someone collapses or simply falls off their chair. The procedure is always the same: check, call, and press.
- Check – this shouldn't take longer than ten seconds. Does the person respond when I speak loudly or gently shake their shoulders? Is he or she still breathing normally? It's important to know: When a brain dies, people sometimes still breathe. However, this is more like gasping, definitely not normal breathing. If you're unsure, you should call 112 now. The control center will help you with the check.
- Call. If the person is unresponsive and not breathing normally, call 911. The dispatch center will then assist you with CPR if necessary; simply put the call on loud.
- Pressure, or chest compressions. One hand is placed on the center of the chest, the other on top. Then, with arms outstretched, shoulders directly over the pressure point, apply pressure about five to six centimeters deep. Now it's all about pressure, release, pressure, release – without stopping, until the emergency services arrive. If you're not alone, you take turns after about two minutes at the most.
By the way, the frequency of pressing the button is about twice per second. I recommend everyone memorize a song they can recall in an emergency. The classic is "Stayin' Alive" by the Bee Gees, but Strauss's Radetzky March or Helene Fischer's "Atemlos" also work.
Can you do anything wrong during resuscitation?
Böttiger: There are three things you can do wrong. First, doing nothing at all—that's the worst possible thing. The second mistake is not recognizing cardiac arrest and placing the person in the recovery position. That's about as effective as doing nothing at all. Unfortunately, the recovery position is so deeply ingrained in many people's minds that it's often mistakenly used even in cases of cardiac arrest.
The third mistake is not pressing hard enough during CPR or not releasing pressure sufficiently afterward. Many people are worried about breaking the person's ribs and are too hesitant. Even in instructional videos, I repeatedly see that the pressure is not applied hard enough.
Pressing five to six centimeters deep is quite a lot. Ribs often break as well. But these fractures heal – the first priority is the person's survival. As an emergency physician, when there are broken ribs, I usually know that the person was resuscitated well.
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