Understanding What You See & Hear During CPR

What’s happening to my loved one during CPR?

Many questions that families who witnessed their loved ones’ cardiac arrest have are experiential. They involve what they felt, saw, and heard. One way to support healing is to get an understanding of those experiences— coming to terms with what occurred or why it occurred. Based on our experiences, we have compiled a list of the most frequently asked questions.

What’s happening to my loved one during CPR?

It is normal for someone to have blood coming from their mouth during or after a cardiac arrest. There are several reasons this may happen. As the person goes into cardiac arrest, they may have a seizure-like episode resulting from hypoxia (a lack of oxygen to the brain). During this fit, they may bite on their tongue, resulting in blood coming from the mouth. In addition, they may suffer trauma to the head, mouth, or jaw from the fall that could happen after they lose consciousness from their cardiac arrest, resulting in bleeding. Doing compressions on someone does cause bruising to occur but rarely breaks ribs or causes bleeding from a punctured lung.

Why was there froth, blood-tinted foam, or vomit?

When someone is unconscious, a buildup of saliva occurs in the back of the throat, which is moved around when CPR is performed and air passes in and out of the airway. This causes the froth or tiny bubbles around or inside the mouth. Light pink or blood-tinted foam is caused by a buildup of fluids in the lungs. This normally occurs after the heart goes into failure and is not able to move blood effectively through the lungs. In some cases, it can spill out uncontrollably. The ribs partially cover a person’s stomach. When doing compressions on the chest, pressure can build up inside the body, which can force out stomach contents or vomiting.

Why did the belly move so much when I did compressions?

During cardiac arrest, muscle tone is lost throughout the body, making a person less rigid or tense. During compressions, you are applying force to the chest, and this causes movement. It’s also possible that with compressions and artificial breathing, air can end up in the stomach, making it bloated looking.

Why did they snore, gasp, or make strange sounds?

This is called agonal breathing, an abnormal type of breathing that is more of a reflex. It can give the illusion that someone is breathing and could be short-lived or last for hours. Agonal respirations are common, occur in over half of witnessed cardiac arrests, and may indicate that there is still brain function left.

Why were they twitching or having seizure-like movements?

Many heart conditions, including cardiac arrest, cause loss of consciousness which comes with short-lived abnormal movements that look like convulsions or seizures. This is due to a lack of oxygen to the brain. You may see a slight twitch in the arms or legs; the arms may bend in towards the body or straighten outward; or the hands may form into a claw or a fist, or face and eyeball fixed to one side. Some may have true seizures after their cardiac arrest.

Why did their color change so much and so fast?

When someone goes into cardiac arrest, the skin color begins to change almost immediately. The person may appear very pale initially when circulation becomes compromised, but discoloration will occur rapidly when the heart stops pumping altogether. A bluish tinge to the skin indicates that a person has a low concentration of oxygen in the blood, often most apparent around the lips, mouth, and fingertips. It can be frightening when seen for the first time.

Why did they urinate or defecate?

Our brain and nerves regulate the bladder and rectum and keep them from leaking. When cardiac arrest occurs, muscles relax and the nerves that control bodily functions stop functioning properly. The person will likely urinate if they have fluid in their bladder and may also defecate.

Why did their eyes stay open?

This occurs in about half of all cardiac arrests and the look is often described as “eyes wide open with alarm, staring into nothingness.” During cardiac arrest, the central nervous system shuts down; pupils dilate and do not respond to light. The eyelids also lose tension. Many who have acted to save a life remember the look in their eyes.

Why did their ribs break or crack?

When doing chest compressions, it takes about 27 kg (60 lbs) of downward force to compress an adult’s chest to the appropriate depth of 5-6 cm (2 in). It is more likely that a person doing CPR who felt a pop or crack was feeling the connective tissue (cartilage) that binds the ribs and the bone in the middle of the chest (sternum) together. Ribs do have some flexibility to bend with chest compressions. However, if the cartilage completely separates from the bones it will likely create a ‘loud’ pop and can be felt when doing compressions. Rib fractures do happen and are common. It can be a disturbing experience for rescuers—a sensation that is hard to describe to those who have not felt it.

Thank you to our contributors

Paul Snobelen & Sachin Agarwal