EMT here. CPR rarely works, and sometimes when it does work the result is permanent brain damage so the patient dies the next day anyway.
Nevertheless it's worth doing on people who are having e.g. a sudden cardiac event because you only do CPR on dead people. Which means as long as they died because of some single-point correctable failure, it doesn't hurt to try CPR because it might succeed and that's better than being dead.
OTOH if they died because of multisystem organ failure or distributed catastrophic blunt-force trauma, CPR will never bring them back.
Medical professionals know all this, and as the article points out the moral distress of failed CPR is related not to the fact that it so often fails but that it's inappropriate to even start CPR on an 80 year old patient in a nursing home who has dementia.
> Poor outcomes are not only limited to death. People who survive CPR suffer physical injuries. More than 70 percent of people who receive CPR experience rib fractures, with an average of 7.6 broken ribs.
What happens to the control group of people who don't receive CPR?
Usually fatal within minutes. Broken ribs are survivable (on their own), and are certainly preferable when compared with the outcome of death.
Though I've noticed with the medical profession, speaking as a dumb firie, any outcome less than perfect is considered a 'complication'.
I've been under the knife a few times for various reasons, I've noticed this more and more. Slight bleeding from a closed incision site after surgery, whilst normal, is still "a complication" and a "poor outcome" despite being totally normal.
Perhaps there needs to be more nuanced language when describing these outcomes? What about "probable deviations" for things that are technically complications, but are more or less expected/normal?
Regarding the CPR training we were given: "if you're not breaking ribs, you're not pressing hard enough" (1/3rd chest depth). 'CPR' shown on TV shows and movies, 'rubber bendy arms', is woefully inadequate and I wonder how much of this is contributing to the mortality rate of cardiac events?
Fortunately a lot of AEDs these days will be able to tell you whether you're pressing hard enough with a pressure sensor embedded in some pads.
> In reality, people who undergo CPR outside of a hospital setting survive only 10 percent of the time. Within a hospital setting, CPR survival rates are only a bit higher — about 17 percent.
A better title: CPR is successful, just not as successful as people think it is.
Whoever thinks a 1/10 (or nearly 1/5!) shot at not dying otherwise is bad odds clearly doesn’t value their own life. I’ll take all my ribs being broken + being alive for even a week vs being dead and no broken ribs any day of the week. I’d also traumatize myself if I knew I was giving someone a 1/10 (or nearly 1/5!) shot at being alive and not dead. Absolutely none of the “downsides” they cite outweigh fucking dying.
Clicking through to one of the references[0] in the article suggests that a little over 40% of people successfully resuscitated never wake up. So that drops us from 10% out-of-hospital / 17% in-hospital to 6%/10%.
That's still not nothing, but you also need to look at what percentage end up with severe enough brain damage that they're not really the same person anymore, and might have preferred death over that situation.
I value my life quite a lot, but I also value quality of life. I think there are quite a few physical and (especially) mental disabilities that I might not want to live with.
To your point about "ribs broken & alive for a week", I suspect that situation would be helpful for my loved ones to be able to see me and say goodbye, but not so helpful for myself.
> I’ll take all my ribs being broken + being alive for even a week vs being dead and no broken ribs any day of the week.
If you'd ever spent time around a nursing home, you probably wouldn't say that. Quality of life matters, a lot. Not saying I have a DNR, but these are serious conversations to have before it's too late. I think what's really telling is how doctors and nurses treat themselves. They are almost never seeking maximum days alive no matter the physical and mental cost.
I wonder whether it matters as to how those requiring CPR ended up in hospital in the first place: did they suffer a cardiac event outside of hospital, and arrive at hospital with CPR being continued, as opposed to those who were in hospital to begin with, but suddenly required CPR for whatever reason?
That line in itself seems to suggest that the likelihood of CPR being successful increases slightly when a victim is transported to hospital with CPR continuing throughout from the time of their cardiac event, versus those who never make it to hospital, because the CPR givers stop (exhausted, unable to continue) or because efforts before reaching hospital are considered pointless/time-of-death called (as it was clear to medical professionals that CPR isn't going to bring a clearly dead person back to life).
EMT here. CPR rarely works, and sometimes when it does work the result is permanent brain damage so the patient dies the next day anyway.
Nevertheless it's worth doing on people who are having e.g. a sudden cardiac event because you only do CPR on dead people. Which means as long as they died because of some single-point correctable failure, it doesn't hurt to try CPR because it might succeed and that's better than being dead.
OTOH if they died because of multisystem organ failure or distributed catastrophic blunt-force trauma, CPR will never bring them back.
Medical professionals know all this, and as the article points out the moral distress of failed CPR is related not to the fact that it so often fails but that it's inappropriate to even start CPR on an 80 year old patient in a nursing home who has dementia.
> Poor outcomes are not only limited to death. People who survive CPR suffer physical injuries. More than 70 percent of people who receive CPR experience rib fractures, with an average of 7.6 broken ribs.
What happens to the control group of people who don't receive CPR?
Usually fatal within minutes. Broken ribs are survivable (on their own), and are certainly preferable when compared with the outcome of death.
Though I've noticed with the medical profession, speaking as a dumb firie, any outcome less than perfect is considered a 'complication'.
I've been under the knife a few times for various reasons, I've noticed this more and more. Slight bleeding from a closed incision site after surgery, whilst normal, is still "a complication" and a "poor outcome" despite being totally normal.
Perhaps there needs to be more nuanced language when describing these outcomes? What about "probable deviations" for things that are technically complications, but are more or less expected/normal?
Regarding the CPR training we were given: "if you're not breaking ribs, you're not pressing hard enough" (1/3rd chest depth). 'CPR' shown on TV shows and movies, 'rubber bendy arms', is woefully inadequate and I wonder how much of this is contributing to the mortality rate of cardiac events?
Fortunately a lot of AEDs these days will be able to tell you whether you're pressing hard enough with a pressure sensor embedded in some pads.
The redundancy in the title is killing me.
Anyway, the core is
> In reality, people who undergo CPR outside of a hospital setting survive only 10 percent of the time. Within a hospital setting, CPR survival rates are only a bit higher — about 17 percent.
And the rest is reasons and consequences.
A better title: CPR is successful, just not as successful as people think it is.
Whoever thinks a 1/10 (or nearly 1/5!) shot at not dying otherwise is bad odds clearly doesn’t value their own life. I’ll take all my ribs being broken + being alive for even a week vs being dead and no broken ribs any day of the week. I’d also traumatize myself if I knew I was giving someone a 1/10 (or nearly 1/5!) shot at being alive and not dead. Absolutely none of the “downsides” they cite outweigh fucking dying.
Clicking through to one of the references[0] in the article suggests that a little over 40% of people successfully resuscitated never wake up. So that drops us from 10% out-of-hospital / 17% in-hospital to 6%/10%.
That's still not nothing, but you also need to look at what percentage end up with severe enough brain damage that they're not really the same person anymore, and might have preferred death over that situation.
I value my life quite a lot, but I also value quality of life. I think there are quite a few physical and (especially) mental disabilities that I might not want to live with.
To your point about "ribs broken & alive for a week", I suspect that situation would be helpful for my loved ones to be able to see me and say goodbye, but not so helpful for myself.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC8548866/#Fig3
> I’ll take all my ribs being broken + being alive for even a week vs being dead and no broken ribs any day of the week.
If you'd ever spent time around a nursing home, you probably wouldn't say that. Quality of life matters, a lot. Not saying I have a DNR, but these are serious conversations to have before it's too late. I think what's really telling is how doctors and nurses treat themselves. They are almost never seeking maximum days alive no matter the physical and mental cost.
I wonder whether it matters as to how those requiring CPR ended up in hospital in the first place: did they suffer a cardiac event outside of hospital, and arrive at hospital with CPR being continued, as opposed to those who were in hospital to begin with, but suddenly required CPR for whatever reason?
That line in itself seems to suggest that the likelihood of CPR being successful increases slightly when a victim is transported to hospital with CPR continuing throughout from the time of their cardiac event, versus those who never make it to hospital, because the CPR givers stop (exhausted, unable to continue) or because efforts before reaching hospital are considered pointless/time-of-death called (as it was clear to medical professionals that CPR isn't going to bring a clearly dead person back to life).
This need some clarification.Not all CRP should be put in one bucket.
Out of hospital/unwitnessed arrests - mortality is bad.
In hospital/witnessed arrests - CRP mortality was better.
Downtime (ie time without perfusion makes a difference) the longer it is - the worse the outcome. The difference between long and short is minutes.
That doesn't mean CRP isn't worth trying. The hard part is making sure families understand when futility begins. Some families never get there.