July 15, 2013

CPR’s Shortcomings? (*Modified)

A July 10, 2013 article on has sparked some passionate discussion among the emergency care community.

The premise? Despite what we see in medical dramas on television and in the movies, statistics suggest that CPR is an overall ineffective technique, and its use a source of conflict in the medical world.

Dramatized CPR Scene from British TV Show "Mile High". This scene does not reflect proper CPR technique and is purely for illustration purposes. Source: Youtube

You’ll get no argument from us about TV and movies. A CPR rescue is a juicy story line, filled with drama and heroism; of course almost everyone survives on the big (or little) screen.  The CNN article cites a Duke University study that reviewed 97 episodes of some popular medical dramas between 1994-1995, and discovered that 75% of the patients who received CPR in the stories survived.

75%. We should be so lucky in the real world. Yet it’s hard to argue that television and film don’t heavily influence our perceptions of reality. For many, seeing CPR on a show is the only exposure they might have to emergency response, and unrealistic expectations can easily follow. Actual statistics on survival with CPR intervention aren’t nearly as rosy.

The article goes on to review potential outcomes of CPR revivals on patients with a terminal illness, a chronic illness, or those who do not revive from CPR until after their brains have been without oxygen for a long period. A doctor interviewed in the article refers to these as the “unhealthy dead”; those who were dead, then revived, but who continue to suffer, sometimes directly from the effects of that revival attempt.

Those after-effects, among many other reasons, have prompted some healthcare practitioners to obtain “Do Not Resuscitate (DNR) Advance Directives” so that CPR will never be attempted on them.

The article is a good reminder that any emergency in which CPR is viable response is indeed a crisis situation; not everyone survives, or comes out unscathed from the revival process.

The reality is, he or she is dead. If you do nothing, it’s a guarantee that victim will stay dead. Those are the only givens.

The reality is, he or she is dead. If you do nothing, it’s a guarantee that victim will stay dead. Those are the only givens.

It would seem that the article’s implied take-away point is that CPR should never be attempted. So how should we respond to this? Should a bystander who is trained in CPR refrain from acting in an emergency? We learn in our training programs that survival rates are low. We understand there might be mitigating health factors for any given patient, but what is the reality of the victim of sudden cardiac arrest who has collapsed in front of us? For us here at HSI, the answer is clear and unequivocal.

CPR, First Aid, & AED Training from ASHI and MEDIC First Aid

At the end of the day, we know that human life is the most vitally important thing on this planet. We say this without apology. When we encounter someone who has suffered a cardiac arrest, we don’t see someone with “multiple co-morbidities”, or “unhealthy dead”. We see someone’s loved one… someone’s father or mother, someone’s grandpa or grandma, sister, brother, cousin, the love-of-your-life. We know that technically, they are already dead, and that if we do nothing, it’s a guarantee that the victim will stay dead.  But, part of being human is to rail (and prevail!) against the odds.

In our day-to-day operations, we are constantly looking at ways to improve CPR survival rates, the learning retention, the skills retention, and the technology surrounding CPR, all of it. We know the odds are long, but we welcome the fight.

As your partners in education, you can read this kind of article that reduces life to statistics and numbers, and yet when you meet someone who has been saved through CPR, every single class, every single effort, every late night prepping class is instantly worth it. This writer has been humbled by having someone come up and say “You guys saved me. Thank you.” Haven’t you heard that before?

We have, and there is no greater feeling in the world than to have someone thank you for saving their life, or for teaching someone or equipping someone to save their life. For this reason, we will jump in to administer CPR, or to train someone or equip someone to train someone. Yes. Every. Single. Time. Even against the odds and without any TV cameras rolling.

You, our customers, are our partners in this together. What feedback do you have for us? What improvements could we make together to improve the odds?

*This article was modified to better reperesent the position of Health & Safety Institute