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.