The CPR Mystique
It is estimated that approximately 85% of the time CPR alone is used to resuscitate someone who requires it, it is effective and the person reawakens with perfect cognition. But only on television and in movies. In fact, it worked 100% of the time on the popular show Lost when it was performed at least 7 times during the show’s run. Nobody died on Lost when Jack was doing the compressions!!
In reality, however, it is almost impossible to determine the success rate of CPR only resuscitation, because it has been shown, time and again, spontaneous restart of a heart in sudden cardiac arrest due to ventricular fibrillation or ventricular tachycardia is next to impossible with CPR compressions alone. A shock from a defibrillator is the only proven method to get someone’s heart beating on its own again. And if someone is revived in the field using only CPR, the odds are pretty good they were not in cardiac arrest when they collapsed, but suffering from another ailment or condition which may have resulted in a very weak (undetectable by lay person) heartbeat, and it’s possible the pain from the compressions is the catalyst for them to awaken.
This is not to say CPR isn’t important – in fact, it is crucial to the survival and neurological recovery of someone who has collapsed from sudden cardiac arrest. It keeps the limited supply of oxygenated blood circulating throughout the body until a shock from a defibrillator can be administered or emergency medical services arrives (and administers a shock from a defibrillator). Without CPR, the brain begins to die sooner which can lead to irreversible neurological damage. But will someone spontaneously awaken, dramatically gasping for breath and able to sit up after dying and receiving CPR? Probably not. Especially if you learned your CPR technique from the movies and television.
It’s understood you can’t do actual effective CPR techniques on a conscious, breathing person. You will do more harm than good. So those shots of Jack performing CPR on Rose on the beach in the Lost pilot can’t show him doing actual 2-2 ¼” deep compressions at 100 – 120 per minute because he would most likely crack some ribs on the poor actress and put her into the hospital for real. At least his arms weren’t bent, and they were marginally better than the chest massage Boone was doing. But really? 10 seconds of CPR and Rose dramatically inhales and then he just leaves her there to rescue Claire and Hurley from a falling plane wing. We later see her walking and talking like nothing happened. Let’s chalk this one up to “Rose was probably not in sudden cardiac arrest, but was just unconscious for some other reason.”
Actual medical dramas get it wrong almost as frequently as non-medical shows. House is notorious for bent-arm CPR, and defibrillating patients who are “flatlining” (layperson’s term for asystole – when there is absolutely no heartbeat at all). Someone in asystole cannot be resuscitated with a defibrillator – there is no fibrillation to DE-. And no matter how high you jack the joules, odds are they have gone to the choir invisible and you need to come up with another solution.
Do these misrepresentations of CPR do any harm? It is worrisome they may prompt those doing CPR to expect to need nothing other than compressions and breaths to revive someone. This may lead to them NOT searching for, or sending someone else to locate, an AED. It may also lead to unrealistic expectations of their rescue efforts and a sense of failure afterward, even though they truly believe they were doing everything they could. Even when an AED is used, the survival rates for sudden cardiac arrest are only in the 30% range (which is far better than the 10% when an AED is not used by a bystander). Some people can simply not be revived no matter what treatment is administered. Their heart may be too badly damaged, they may have suffered some other trauma, or they may have been found too late.
CPR classes should always stress the importance of proper technique, using an AED when it is available, to not expect a dramatic revival on scene, and to NEVER feel like a failure if the patient doesn’t survive. Doing something is always better than doing nothing.
January 18, 2017 at 7:17 am, Brian Gould said:
The most important thing for non-professional CPR classes is to let students know that they cannot hurt the person in cardiac arrest.
Most CPR students are shocked to learn how hard it is to do CPR for just a few minutes – never mind more than 10 when waiting for an ambulance.
Then, people should be aware how messy a CPR scene is. Dead people don’t hold in their bodily fluids very well.
January 18, 2017 at 9:38 am, Jack Carney said:
Way back in the early ’70’s, Dr. Champion, then director MedStar trauma center in Washington, D.C., told my class of EMT’s that CPR rarely saves lives, that it merely interrupts the dying process until an AED can be employed. I repeat that to all of my classes.
January 18, 2017 at 10:35 am, Chuck Hoagland said:
As a CPR instructor and Critical Incident Stress team member, I always told my CPR classes the percentages of success, and the fact that the person was clinically dead when in cardiac arrest, so all they could do was possibly improve the condition, and not to beat them selves up if the person does not survive. Do all you can in the way you were trained and hope for the best.
January 18, 2017 at 10:37 am, AED Superstore said:
All good points and well taken!
January 18, 2017 at 3:01 pm, Carl Erbe said:
I typically begin a class by asking everyone to ask a question they would like answered about CPR, or make a comment about something they’ve seen or heard about the topic. That can clear up some of the myths and misconceptions before a class begins. I’ve found that some students are more receptive to the material presented when they’re not subconsciously waiting for instruction that will validate what they thought they might already know.
January 18, 2017 at 3:12 pm, AED Superstore said:
That’s a great way to initiate a training session! Keep up the good work!
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