I was dead on the street at 15 after being hit by a car (my fault). A good Samaritan stopped, administered CPR and resuscitated me. Forty six years later and I never got to thank him. I only know his first name (Mark).
CPR is a good thing and hopefully this article will not make people think twice before administering it.
Critical care medic here. Adult CPR at least has some evidence in its favor on a population level, but only as a bridge to using electricity. CPR alone is merely slowing deaths arrival.
There is NO evidence to support any of the commonly used advanced cardiac life support drugs in terms of functioning brain leaving the hospital. Epinephrine (for arrest, not shock or anaphylaxis), atropine, lidocaine, amiodarone, procainamide, digitalis, etc. Its electricity or bust.
The key point is that the AED (automatic electric defibrillator) will tell you if you have a shockable rhythm.
Many modern AED's can be used by untrained people, so if you see a cardiac arrest, find the nearest AED and deliver it and/or follow its (brief) instructions. Once you know this, you'll start tracking the last one you saw, and you'll find them more ubiquitous than you realized (and start advocating for one in your office).
(And if you are doing CPR, the breathing part is less important than the chest compressions. Blood flow is more important than oxygenation. But always/only follow current guidelines/training.)
EMT here. I've had exactly one save in my career from CPR without external defibrillation. That save happened only because of epi, and the patient was disconnected the next day because of brain death.
So yeah, CPR is great but if you don't also have an AED, it's just theater.
Caveat: If you call 911 [in the USA] they will bring an AED! So don't let the fact that you don't own an AED stop you from starting CPR. Just be sure somebody calls 911 also.
"An international team of researchers looked at 49,555 out-of-hospital cardiac arrests that occurred in major U.S. and Canada cities. They analyzed a key subgroup of these arrests, those that occurred in public, were witnessed and were shockable. The researchers found that nearly 66 percent of these victims survived to hospital discharge after a shock delivered by a bystander."
Obviously, 66% beats the 10% survival rate in the original article (getting CPR alone from bystanders). The takeaway: AEDs can make a BIG difference. Curious that the article failed to mention that.
Also, a witnessed arrest likely means it's because the heart stopped vs the heart could no longer operate because of other problems. Also, vfib is far more salvageable than not operating at all.
There’s a curious movement of people who spend their life afraid they will ‘endure’ CPR and live to tell the tale. And they come up with scare pieces like this one.
Sorry, if you go as far as getting a tattoo because you’re so afraid you will be resuscitated, you’re in way over your head and it’s time to focus your energy on something constructive.
> The traumatic nature of CPR may be why as many as half of patients who survive wish they hadn't received it, even though they lived.
It's the peak of coming up with data to make a story. The study was only for old people with chronic disease, where lot of them wouldn't want any life saving treatment let alone CPR. And even in that group if >50% of said they were happy to have gotten CPR.
A common expression is, if they need CPR, they're _dead_ at that point and you can only improve their chances of reaching definitive care, even if it's long odds. And yes there will probably be side effects to complain about. If the patient decided they didn't want that, ahead of time, they could have a DNR in place.
The title was changed and not necessarily for the better. This is a piece about the right to die with dignity, the right for elderly people to say "Yeah, I'm ready to let go. Heroic measures to keep me technically alive make no sense at this point."
In some cases, you aren't prolonging their life. You're dragging out their death and torturing them to do so.
I am also reminded of the scene in Aliens 3 where the android asks Ripley to simply shut him down because he's lost so much functionality that keeping him "alive" has no appeal for him.
Yep, my mom (84) had an older friend years ago. Had a medical directive that said "do not resuscitate" and her daughter ignored it. She spent a year in hospice before she died totally angry at her daughter for not following directions. Her quality of life was terrible. My mom has talked about this many times and sternly told me not even think about ignoring her directive.
I'll always remember my Great Uncle, who begged my Grandfather every time he saw him, to bring him a pistol so he could end it and escape the torture that was his chemo treatments.
There is absolutely a point past which all quality of life is destroyed and it isn't worth continuing care.
What's the point of this article? Are we trying to get rid of CPR now so that people don't bother doing it because it has a low success rate? It is literally a last desperate effort to save someone in a really bad situation.
I don't think anyone is under the allusion that CPR has like a 95% success rate do they?
They link a study where they polled people shortly after a family member was admitted to the ICU about the effectiveness of CPR.
My partner is a nurse, so I already knew that the odds of community-delivered CPR were about 10% (although now I'm curious how those odds change when an AED is available) and about the cracking of ribs.
I think what this article could've emphasized more is that more people should learn about and consider Advance Directives and DNR (do not resuscitate orders), particularly for patients who are nearing the end of their natural life.
As it reads now it seems to suggest that bystanders should not bother doing CPR in the community, which I think is incorrect and borderline dangerous advice.
Make people aware that performing CPR on terminally ill people is not self-evidently a good idea. See "A 'natural death' may be preferable for many than enduring CPR" which is a title.
> She has written about performing chest compressions on a frail, elderly patient and feeling his ribs crack like twigs. She found herself wishing she were "holding his hand in his last dying moments, instead of crushing his sternum." She told me that she's had nightmares about it. She described noticing his eyes, which were open, while she was performing CPR. Blood spurted out of his endotracheal tube with each compression.
> "I felt like I was doing harm to him," she told me. "I felt like he deserved a more dignified death."
Survival rates aside, CPR on the elderly can be particularly brutal.
CPR is basically beating the crap out of someone in order to drag them back from death.
You're talking about inflicting serious damage on people who take damage more easily, struggle to recover and are significantly more likely to suffer medical complications from even minor injuries.
We like to place human life in an echelon of the sacred above all other life - and sometimes this leads to us being kinder to our pets than we are to ourselves.
A healthcare system that prioritises quality over quantity of life could yield better results, but that's not going to happen as long as things are controlled by a gluttonous hydra of an industry that has a fiduciary duty to its stockholders, but no real duty of care to the patients.
When the American Red Cross trained me in CPR, they told me this statistic, and told me that the reason they told me this was so that I wouldn't blame myself if the victim dies anyway (the most likely outcome.)
> I don't think anyone is under the allusion that CPR has like a 95% success rate do they?
When I was first taught CPR in school, it was taught without any reference to the survival statistics. The impression I got was that it was very effective.
I don't know about 95% success rate, but I'd bet a lot of people think it has at least a 70% success rate.
Doing CPR is scary and hard, and if it's okay to teach people that while it probably won't work, it won't make things worse, and if you're lucky it'll save a life.
Transparency is a small kindness to help the people who do CPR not beat themselves up when it (probably) fails.
I was actually surprised to learn that survivors are in the upper single digits. After all, when you start CPR, people are already dead. Personally, I had to do CPR twice (as a paramedic), and sadly neither of the patients survived.
Generally CPR is performed when there is no pulse or breathing as a last ditch effort to keep a brain viable until a full medical team can do their work.
In other words CPR is performed on people who show no signs of life/are already dead.
The survival rate for the control group is 0, so it is kind of a miracle that anyone survives.
The real point of CPR is to bridge their life while you rush to get them an AED. Without the AED the chance of their heart restarting permanently is vanishingly low ... Last few times I had first responder training it was said to be less than 15% chance of survival for a patient given CPR, and you'll only hear about this if you ask.
The last time I had first responder training the guy sitting next to me was drowned by a surfing accident but it was his great fortune that on shore there was a national expert giving rapid water rescue training and they had this guy out of the water and his heart restarted in 5 minutes. So that is why he was taking first responder training himself!
I'm a survivor of cardiac arrest and was resuscitated with an AED and CPR. I've gone through a lot but I'm glad to be alive, have an implanted ICD now, and I'm glad some employee didn't refuse to do CPR on me.
I wasn't conscious for the event and the entire following week, but they didn't break any of my ribs. Maybe the AED allowed them to be less violent.
Sounds like you were fortunate to have multiple people around, an AED nearby, and someone well-trained. You’re probably right that AED helped prevent physical damage, though that may also be due to good technique and or your anatomy. The sooner that the AED goes on and restarts sinus rhythm, the fewer compressions required.
I didn't know about the low success rate of CPR, but I have been very well aware of the potential damage. When I was a paramedic (as an alternative to military service) I once had to perform CPR to an old lady and I heard her rips crack. One of the worst experiences in those 9 months...
The one time I administered CPR both victims of the accident I stopped at died. In retrospect they were already goners (both ejected from the car) and I didn’t know what I was doing - hell none of us really did, but we tried.
It was objectively one of the most traumatic experiences of my life and I used to dream about those people’s faces for a long time - indeed I can still see them if I try. Regardless, we tried and I wouldn’t have it any other way. We tried.
I wrote a poem about it a few years ago:
Violence
Do you people know what it looks like when a man dies?
What you think his fucking soul flies?
As he serenely and comfortably lies,
And he flutters his contented eyes?
Not at all - there’s blood and pain,
And vomit in his mouth,
and foul brutal smells of bile and shit,
and his eyes look crazy and wild,
as you pound on his chest to exhaustion,
“Scoop out the mouth - take those kids out of here, somebody fucking call 911!”
They don’t tell you CPR never works,
Or how the body jerks,
Then the EMT smirks,
“I can’t zap him again, but dudes dead.”
So it was done, and I drove my truck to the truck stop to buy gas and clean the blood from my hands and jacket and reconcile with the two ghosts that had crawled into my head.
Not sure what the situation is in the US, but I've taken 3-4 first aid courses in my life (it's compulsory to get a driver's license where I live). Every time, they told us that CPR survival rates were abysmal if we aren't also using an AED. IIRC, with an AED the survival rate goes up significantly -- though this article states that in-hospital survival rates are only at 17%, which indicates it's not all that great with AED, either.
"The 2000 Federal Cardiac Arrest Survival Act grants those who administer CPR or use an AED immunity from civil charges, except in instances of willful misconduct or gross negligence."
That should make it less risky to try and help in the U.S. But apparently it can still be a choice that's easy to get wrong. That makes me less likely to jump in as a bystander, and to bias intervention toward healthier looking victims who look like they could tolerate the treatment.
This isn't a secret. I was required to be CPR Certified for a decade. Every class I ever took, the instructor made it clear that it only makes a small difference in survival outcomes, in order to teach students that "you shouldn't be scared to do it." If done properly you should break ribs. They also teach this in classes. I don't think anyone is under the illusion that CPR is a hugely high-percentage life saving technique, except maybe the public at large, but the public at large believes a lot of stupid, untrue things.
This article doesn’t really address statistics for younger people. I feel like the headline should be: should elderly people be given CPR? For me the answer is a strong no. Why on Earth would you give CPR to a 90-year old person!?
> survival after out-of-hospital CPR dropped from 6.7% for patients in their 70s to just 2.4% for those over 90
TL;DR CPR slightly increases the odds for someone otherwise healthy and young but is much less effective for the old and the chronically ill.
IIRC from prior CPR classes (own life data), 'correctly done' chest compressions are extremely violent, they often break ribs to get that compression of the heart between the rib cage and spine. It's a last-ditch effort with COSTS. If there's an AED around to use instead that would be FAR more preferable.
"""
But the true odds are grim. In 2010 a review of 79 studies, involving almost 150,000 patients, found that the overall rate of survival from out-of-hospital cardiac arrest had barely changed in thirty years. It was 7.6%.
Bystander-initiated CPR may increase those odds to 10%. Survival after CPR for in-hospital cardiac arrest is slightly better, but still only about 17%. The numbers get even worse with age. A study in Sweden found that survival after out-of-hospital CPR dropped from 6.7% for patients in their 70s to just 2.4% for those over 90. Chronic illness matters too. One study found that less than 2% of patients with cancer or heart, lung, or liver disease were resuscitated with CPR and survived for six months.
"""
There's at least a small skew in the numbers as well. My wife was instructed to perform CPR by a 911 dispatcher on someone she found who had died in their sleep, and kept talking her through the instructions until paramedics arrived.
I'm assuming this is counted in the broader "survival rate" numbers. That's not to say that the overall message is wrong, but CPR being administered to the dead, or those in medical distress who wouldn't benefit from it, will obviously decrease the overall effectiveness scores.
Complete anecdata, but a few months ago a neighbor of mine successfully resuscitated another neighbor with CPR. There was an AED present, but from what I heard, it did not recommend a shock. The person who collapsed is around 70 years old. Sometimes, it does work! There clearly are some cases where it would be crazy not to try it.
[+] [-] anonymousiam|2 years ago|reply
CPR is a good thing and hopefully this article will not make people think twice before administering it.
[+] [-] uberuberuber|2 years ago|reply
There is NO evidence to support any of the commonly used advanced cardiac life support drugs in terms of functioning brain leaving the hospital. Epinephrine (for arrest, not shock or anaphylaxis), atropine, lidocaine, amiodarone, procainamide, digitalis, etc. Its electricity or bust.
Just one of many reviews on this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129833/
[+] [-] w10-1|2 years ago|reply
The key point is that the AED (automatic electric defibrillator) will tell you if you have a shockable rhythm.
Many modern AED's can be used by untrained people, so if you see a cardiac arrest, find the nearest AED and deliver it and/or follow its (brief) instructions. Once you know this, you'll start tracking the last one you saw, and you'll find them more ubiquitous than you realized (and start advocating for one in your office).
(And if you are doing CPR, the breathing part is less important than the chest compressions. Blood flow is more important than oxygenation. But always/only follow current guidelines/training.)
[+] [-] dreamcompiler|2 years ago|reply
So yeah, CPR is great but if you don't also have an AED, it's just theater.
Caveat: If you call 911 [in the USA] they will bring an AED! So don't let the fact that you don't own an AED stop you from starting CPR. Just be sure somebody calls 911 also.
[+] [-] JumpCrisscross|2 years ago|reply
[+] [-] FireBeyond|2 years ago|reply
[+] [-] randcraw|2 years ago|reply
https://newsroom.heart.org/news/cardiac-arrest-survival-grea...
Obviously, 66% beats the 10% survival rate in the original article (getting CPR alone from bystanders). The takeaway: AEDs can make a BIG difference. Curious that the article failed to mention that.
[+] [-] LorenPechtel|2 years ago|reply
[+] [-] tinus_hn|2 years ago|reply
Sorry, if you go as far as getting a tattoo because you’re so afraid you will be resuscitated, you’re in way over your head and it’s time to focus your energy on something constructive.
[+] [-] YetAnotherNick|2 years ago|reply
It's the peak of coming up with data to make a story. The study was only for old people with chronic disease, where lot of them wouldn't want any life saving treatment let alone CPR. And even in that group if >50% of said they were happy to have gotten CPR.
[+] [-] imglorp|2 years ago|reply
[+] [-] DoreenMichele|2 years ago|reply
In some cases, you aren't prolonging their life. You're dragging out their death and torturing them to do so.
https://news.ycombinator.com/item?id=19598562
I am also reminded of the scene in Aliens 3 where the android asks Ripley to simply shut him down because he's lost so much functionality that keeping him "alive" has no appeal for him.
[+] [-] e40|2 years ago|reply
[+] [-] jgeada|2 years ago|reply
Estimates range from 12% to 25% of lifetime healthcare expenses are accrued on the last year of life [eg https://www.cms.gov/Research-Statistics-Data-and-Systems/Res...]
For profit healthcare is an obscenity.
[+] [-] Arrath|2 years ago|reply
There is absolutely a point past which all quality of life is destroyed and it isn't worth continuing care.
[+] [-] boringg|2 years ago|reply
I don't think anyone is under the allusion that CPR has like a 95% success rate do they?
[+] [-] ghostpepper|2 years ago|reply
My partner is a nurse, so I already knew that the odds of community-delivered CPR were about 10% (although now I'm curious how those odds change when an AED is available) and about the cracking of ribs.
I think what this article could've emphasized more is that more people should learn about and consider Advance Directives and DNR (do not resuscitate orders), particularly for patients who are nearing the end of their natural life.
As it reads now it seems to suggest that bystanders should not bother doing CPR in the community, which I think is incorrect and borderline dangerous advice.
[+] [-] matkoniecz|2 years ago|reply
> She has written about performing chest compressions on a frail, elderly patient and feeling his ribs crack like twigs. She found herself wishing she were "holding his hand in his last dying moments, instead of crushing his sternum." She told me that she's had nightmares about it. She described noticing his eyes, which were open, while she was performing CPR. Blood spurted out of his endotracheal tube with each compression.
> "I felt like I was doing harm to him," she told me. "I felt like he deserved a more dignified death."
[+] [-] yarg|2 years ago|reply
CPR is basically beating the crap out of someone in order to drag them back from death.
You're talking about inflicting serious damage on people who take damage more easily, struggle to recover and are significantly more likely to suffer medical complications from even minor injuries.
We like to place human life in an echelon of the sacred above all other life - and sometimes this leads to us being kinder to our pets than we are to ourselves.
A healthcare system that prioritises quality over quantity of life could yield better results, but that's not going to happen as long as things are controlled by a gluttonous hydra of an industry that has a fiduciary duty to its stockholders, but no real duty of care to the patients.
[+] [-] George83728|2 years ago|reply
[+] [-] nordsieck|2 years ago|reply
When I was first taught CPR in school, it was taught without any reference to the survival statistics. The impression I got was that it was very effective.
I don't know about 95% success rate, but I'd bet a lot of people think it has at least a 70% success rate.
[+] [-] User23|2 years ago|reply
Any intervention needs to be judged against the real alternatives and not some imaginary ideal case.
[+] [-] oatmeal1|2 years ago|reply
[+] [-] asperous|2 years ago|reply
[+] [-] MengerSponge|2 years ago|reply
Transparency is a small kindness to help the people who do CPR not beat themselves up when it (probably) fails.
*illusion (sorry)
[+] [-] grogenaut|2 years ago|reply
If you had a 1% chance to save your kid by oddly palpitating their chest... I'm betting you'd do it.
Tho as we all know you have to say "live damn you live" and cry a bunch for it to work.
[+] [-] beams_of_light|2 years ago|reply
[+] [-] groestl|2 years ago|reply
[+] [-] Faaak|2 years ago|reply
[+] [-] dghlsakjg|2 years ago|reply
In other words CPR is performed on people who show no signs of life/are already dead.
The survival rate for the control group is 0, so it is kind of a miracle that anyone survives.
[+] [-] williamDafoe|2 years ago|reply
The last time I had first responder training the guy sitting next to me was drowned by a surfing accident but it was his great fortune that on shore there was a national expert giving rapid water rescue training and they had this guy out of the water and his heart restarted in 5 minutes. So that is why he was taking first responder training himself!
[+] [-] User23|2 years ago|reply
[+] [-] dheera|2 years ago|reply
I wasn't conscious for the event and the entire following week, but they didn't break any of my ribs. Maybe the AED allowed them to be less violent.
[+] [-] zahma|2 years ago|reply
Happy to hear you are doing better.
[+] [-] spacechild1|2 years ago|reply
[+] [-] piloto_ciego|2 years ago|reply
It was objectively one of the most traumatic experiences of my life and I used to dream about those people’s faces for a long time - indeed I can still see them if I try. Regardless, we tried and I wouldn’t have it any other way. We tried.
I wrote a poem about it a few years ago:
Violence
Do you people know what it looks like when a man dies?
What you think his fucking soul flies?
As he serenely and comfortably lies,
And he flutters his contented eyes?
Not at all - there’s blood and pain, And vomit in his mouth, and foul brutal smells of bile and shit, and his eyes look crazy and wild, as you pound on his chest to exhaustion, “Scoop out the mouth - take those kids out of here, somebody fucking call 911!”
<ah ah ah ah stayin’ alive stayin’ alive> <ah ah ah ah stayin’ alive stayin’ alive>
They don’t tell you CPR never works, Or how the body jerks, Then the EMT smirks, “I can’t zap him again, but dudes dead.”
So it was done, and I drove my truck to the truck stop to buy gas and clean the blood from my hands and jacket and reconcile with the two ghosts that had crawled into my head.
[+] [-] querez|2 years ago|reply
[+] [-] hirundo|2 years ago|reply
That should make it less risky to try and help in the U.S. But apparently it can still be a choice that's easy to get wrong. That makes me less likely to jump in as a bystander, and to bias intervention toward healthier looking victims who look like they could tolerate the treatment.
https://www.cprcertified.com/blog/can-you-be-sued-for-perfor...
[+] [-] dghlsakjg|2 years ago|reply
https://newsroom.heart.org/news/legal-risk-of-not-performing...
[+] [-] unknown|2 years ago|reply
[deleted]
[+] [-] JohnMakin|2 years ago|reply
[+] [-] strunz|2 years ago|reply
>In real life, people similarly believe that survival after CPR is over 75%.
Also:
>I don't think anyone is under the illusion that CPR is a hugely high-percentage life saving technique, except maybe the public at large
You don't think anyone believes this, except almost everyone?
[+] [-] zackkatz|2 years ago|reply
> survival after out-of-hospital CPR dropped from 6.7% for patients in their 70s to just 2.4% for those over 90
[+] [-] mjevans|2 years ago|reply
TL;DR CPR slightly increases the odds for someone otherwise healthy and young but is much less effective for the old and the chronically ill.
IIRC from prior CPR classes (own life data), 'correctly done' chest compressions are extremely violent, they often break ribs to get that compression of the heart between the rib cage and spine. It's a last-ditch effort with COSTS. If there's an AED around to use instead that would be FAR more preferable.
""" But the true odds are grim. In 2010 a review of 79 studies, involving almost 150,000 patients, found that the overall rate of survival from out-of-hospital cardiac arrest had barely changed in thirty years. It was 7.6%.
Bystander-initiated CPR may increase those odds to 10%. Survival after CPR for in-hospital cardiac arrest is slightly better, but still only about 17%. The numbers get even worse with age. A study in Sweden found that survival after out-of-hospital CPR dropped from 6.7% for patients in their 70s to just 2.4% for those over 90. Chronic illness matters too. One study found that less than 2% of patients with cancer or heart, lung, or liver disease were resuscitated with CPR and survived for six months. """
[+] [-] zdragnar|2 years ago|reply
I'm assuming this is counted in the broader "survival rate" numbers. That's not to say that the overall message is wrong, but CPR being administered to the dead, or those in medical distress who wouldn't benefit from it, will obviously decrease the overall effectiveness scores.
[+] [-] Gordonjcp|2 years ago|reply
It might work. You may as well give it a shot, if only to say "well, at least I gave it a shot".
[+] [-] sccxy|2 years ago|reply
[+] [-] three14|2 years ago|reply