Blog #160- 6/7/23
WE NEED TO UNDERSTAND CPR BETTER
By Richard Davis
Cardiopulmonary resuscitation (CPR) is something that has become ingrained in our culture. When someone collapses people are supposed to feel compelled to start pumping on someone’s chest. Communities offer a number of ways for health professionals and lay people to learn the technique and an industry has developed around the use of CPR.
But I wonder if enough people take the time to look at the big picture and weigh the pro’s and con’s of CPR. The technique has been in popular use since the 1970’s and it’s interesting to note that the idea of cardiac compression first came to light in 1878 from experiments with cats.
During my career as a nurse I have done CPR hundreds of times and I have come to the conclusion that it is a good tool to have but it should be used wisely and only after carefully weighing the benefits and possible outcomes.
Consider this report from a recent NPR story. “Many people learn what they know about CPR from television. In 2015, researchers found that survival after CPR on TV was 70%. In real life, people similarly believe that survival after CPR is over 75%. Those sound like good odds, and this may explain the attitude that everyone should know CPR, and that everyone who experiences cardiac arrest should receive it. Two bioethicists observed in 2017 that “CPR has acquired a reputation and aura of almost mythic proportions,” such that withholding it might appear “equivalent to refusing to extend a rope to someone drowning.” 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%.”
And it is worth quoting more of the report for context. “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.”
This kind of information should inform people when they make out living wills and decide what kind of end of life care they want. Most people who fill out the forms don’t know enough about CPR to make an informed judgement whether or not they want it done on them.
I have always felt that people should be able to watch a video of real-life CPR in and out of hospital to get a better sense of what is involved. There are certainly a lot of circumstances where CPR is valuable, especially for younger healthy people whose hearts may stop or experience a life-threatening arrythmia.
Some people might say, “What harm can it do to at least try?” That is a loaded question. The harm for younger healthy people may be minimal but there are risks for elderly people who have chronic diseases. Since the survival rate after CPR is so low why is it even being used? If any other procedure had such a low rate of success it would have been rejected by the medical community. This speaks to the fact that this is not a black and white issue.
I have seen too many elderly people insulted by CPR as their ribs cracked under the pressure of my compressions. Very few of those people survived the process and fewer lived to walk out of the hospital and lead productive lives beyond a vegetative state.
Doing CPR should not be an automatic response when someone collapses, especially if you know their medical history. It is impossible to have that information in the community, so street-level CPR continues to be obligatory until more information is available.
Work on your living will( and update it on a regular basis) and carefully consider whether or not CPR will help you or create misery at the current stage of your life.