How do I understand 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.

Why was there blood in the mouth?

It is normal for some cardiac arrest patients to have blood coming from their mouth during or after a cardiac arrest. There are several reasons this may happen. As the patient goes into cardiac arrest, they may have what is termed a “fit,” resulting from hypoxia (a lack of oxygen to the brain). The patient will fit for a short period whilst going into cardiac arrest, and when doing so, may bite on their tongue, resulting in blood coming from the mouth. In addition, the patient may suffer trauma to the mouth during their cardiac arrest–whilst falling to the ground they may strike their head, mouth, or jaw on something that results in trauma with bleeding. Doing compressions on someone does cause bruising to occur. Rarely is bleeding caused by a punctured lung due to broken ribs.

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. 

A person’s stomach is partially covered by the ribs. 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 a cardiac arrest, there is a loss of muscle tone 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 distended or bloated looking.

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

This is called agonal breathing, an abnormal pattern of breathing that is caused by a brainstem reflex telling the body to continue to breathe while not actually breathing. It can give the illusion that someone is breathing and can be short-lived or last for hours. Agonal respirations are common and occur in over half of witnessed cardiac arrests. For the most part, agonal breathing indicates that there is still brain function, and it’s possible to witness agonal breathing when doing good compressions. It is not an indication of compression quality, just a potential side effect.

Why were they twitching or having seizure-like movements?

Many heart conditions, including cardiac arrest, cause loss of consciousness, also known as syncope, 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 patients undergoing cardiac arrest legitimately could be having a seizure that does not last long.

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 nervous system regulate the bladder and rectum and keep them from draining or leaking. When cardiac arrest occurs, muscles relax and the nervous system that controls bodily functions stops 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. This is commonly what people associated with fracturing a rib. 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

We Appreciate Your Feedback

Please leave any feedback you have regarding the content of this article. Have you found it helpful? What would you change or like to see differently?