CPR's true survival rate is lower than many people think | Hacker News Reader

CPR's true survival rate is lower than many people think

npr.org

208 pointsrntn216 comments

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.

It is a good thing: obviously - you were resuscitated.

I did a first aid course a few months back and one of the attendees (six in total) had done a similar job for a colleague a few years back. Their description was quite something. To be told first hand what happens, corroborating the instructor is a lesson and a half. It isn't pleasant at all and I won't spell it out here. As well as CPR we covered quite a few other things and you are far more likely to encounter choking and the correct response is far more likely to have a good outcome than CPR, so first aid courses are a very good thing.

If I end up having to deliver CPR, I will do it without hesitation. I will do the checks first, mindful that I will be performing what amounts to ABH. A small success rate is better than nothing.

OK so something like 5-10% is the real success rate for CBR. Now, would you be interested in something like 75%?

DEFIBRILLATOR.

A defib will talk you through how to use it but a short course will get you going much quicker. They are just like jump starting a car but instead of croc clips, the wires are connected to sticky pads that you stick on the person. They are battery powered and can be very small and portable. They are nothing like as big as you see on old school TV dramas.

Upside: ~75% chance of resuss. compared to around 5-10% for CPR. No need to potentially break ribs or other unsavoury side effects of battering a person. Downside: Costs around £1000 a pop - they are reusable.

If you own a business, why not grab one, slap it on the wall near to the first aid kit and get the staff clued up. When you get to a certain age (over zero) why not get one at home?

I have not yet followed my own advice yet but I think I will quite soon! Have a chat about it with your staff, family and whoever will listen.

I think that CPR should be likened to camping without a tent, in the Arctic. A defib: glamping, with free Cava! That said, I will still cause ABH on someone that I deem needs it if nothing else is to hand.

You can now get single use defibrillators that are cheaper but they have a limited life span.

All defibs do. The battery and pads need replaced every few years.

I think they work best in combination. The CPR can keep your brain alive long enough for the defib to arrive.

I appreciate the exuberant tone of this message but it’s not quite correct. Defibrillators can get upwards of 60% success rate if given in conjunction with effective CPR. There’s no getting around breaking ribs - defibrillators have to charge, you have to check the pulse and oxygen has to be given. You can’t leave someone pulseless for 60 seconds while you fetch and charge the defibrillator as they will die. All the first aid tools are used in concert.

Also, there are shockable and non-shockable heart rhythms. A defibrillator is not a catch-all solution.

(I have Ventricular Fibrillation and have been de-fibb'd twice, the second time by an implanted device).

Exactly! Defibs can't restart a 'stopped' heart. They instead resynchronise the muscle fibres when the heart's internal rhythm has got messed up for whatever reason. They can (try to) fix a heart that is quivering rather than beating cleanly.

But the defibs themselves can sense the difference and won't apply a shock if the rhythm isn't shockable. You should always get one out and let it try to shock if it can.

Coming back to the main point, when I had my first VF episode, CPR kept me alive long enough for the staff at the place where it happened to find their defib. The doctor at the hospital who implanted my ICD told me that surviving an out-of-hospital cardiac arrest was something like a 1 in 5 chance. The surgical team were clearly of the view that I was very lucky to be there. And, yes, I got broken ribs. This was the most painful thing. I had too sleep sitting up because getting up from lying gown was too painful. Sneezing (and laughing) were also fairly painful. But a small price to pay.

>There’s no getting around breaking ribs

You're usually "just" dislocating the ribs from the sternum (and often tearing the cartilage at that joint). Doesn't feel any less crunchy though...

Indeed. They've been available on Amazon since Amazon was still known so much as a book store that it made headlines that you could get them there, what with their not being books and all.

+1 on doing a first aid course. It's a day or two, it's interesting, and it's a good thing that human beings should be prepared and willing to help one another.

I'm 41 and I've now twice encountered a situation where I should give first aid. The first time was a fatal collision between a bicyclist and a pedestrian, in an affluent suburb: there were actual doctors working on the pedestrian, so after checking an ambulance had been called, I left – no point in gawking.

But I was struck by how little I could have done to help if I'd encountered the accident by myself. So I took a first aid course as soon as I could.

A few years later I was cycling and came across a fellow rider who'd come off and landed on his head; he was just lying there in the path. It was amazing how the training kicked in – I checked for danger to myself, established he couldn't respond to me, established he was breathing, carefully put him in the recovery position, used my bike to wall him off a bit so nobody would ride over him, then went for help (I didn't have a phone on me, the one time I happened not to have it!)

The injured cyclist was fine in the end, he came around after a few minutes and it was then a matter of persuading him to wait until the ambulance folks arrived; he had no concept that he'd been out for multiple minutes, I think from his perspective it had only been a moment. I'm glad I was able to help though. So yeah, if you are able, do a first aid course.

If defibrillators are that effective, making them accessible should be a bigger deal. Why are they so expensive after all this time?

Maybe there could be an Emergency App included in all phones with offline first aid info, a deadman switch that calls 911 if you let go of the button, and maps of the building you're in with are and fire escape plans, if they published one.

Lots of businesses that could afford one still don't have them, why isn't there any legal requirement for million dollar profit places to have them?

That is why statistics are a horrible tool for decision making.

There are so many things that on a statistical basis make no sense. Yet on an individual level it is a life-or-death difference.

> That is why statistics are a horrible tool for decision making.

Statistical illiteracy is a horrible tool for decision making. Statistics is the only tool for decision making other than pure guesswork, because all decisions based on data are statistical inferences. If something doesn't make sense on a statistical basis, it's almost certainly the case that the statistical analysis was naive.

A statistical inference of the probability of survival of a particular patient that doesn't take into account any characteristics of that patient is naive in the extreme. We aren't interested in the average patient, we care about the average patient whose risk profile most closely resembles our patient.

One of the most interesting insights I learned, second-hand from my wife's medical education, is the essentially bi-modal distribution of CPR need. Note: This is an observation based on memory. It may or may not be actually true.

* Group One is people like you. Otherwise healthy people who've had some sort of crazy event. CGR gets your body through an acute moment so it can heal and recover on its own.

* Group Two. People that are already sick or very sick. Cardiac arrest is essentially their body failing. Even if CPR is successful, they're have lots of physical trauma that is extremely hard to overcome. Another cardiac arrest is inevitable.

The article does a terrible job of identifying this difference. If you're a member of the general public and you need to give CPR, there's a huge chance you're giving it to someone in Group One. Most people in Group Two are already hospitalized or in some sort of care setting.

This distinction was my take away from the article.

Yes, the article says that half of the people resuscitated by CPR wished it didn't happen. The linked paper explicitly says this figure is valid for in-hospital administered CPR, so definitely people belonging to group 2.

Yes this was a point of particular emphasis in swiftwater rescue classes since drowning is one of the mechanisms of injury for which CPR can work well to bring someone back who appears dead (not breathing, hard-to-find pulse).

It’s also a scenario in which the breathing part of CPR is particularly valuable. A lot of front-country CPR courses de-emphasize administering breaths in favor of sustaining chest compressions.

> Most people in Group Two are already hospitalized or in some sort of care setting.

No. Disabled and sick people are all around you. This is why you should have been taught in your CPR class to check for a medical ID tag that might, for example, say that the person doesn't want to be resuscitated.

Also just because someone is disabled doesn't necessarily mean they don't want CPR. That's their choice and not yours, just respect it. Denying disabled people CPR without consent during the pandemic in the UK and Canada did significant damage to public education around when you might want not want CPR.

I learned CPR on a Wilderness First Responder course. They keep adding more medical training because the wilderness is increasingly accessible to disabled and sick people. The sidewalk in the middle of civilization is much easier to get to than that.

Edit: This is a reason however to continue CPR longer in certain cases like drowning (especially in cold water) and lightning strikes.

>Disabled and sick people are all around you.

You are conflating "disabled" with "dying". A deaf person will have a decent chance of coming back to normal if they survive CPR. An 85-year-old with heart disease will most likely not. The parent was a little vague, but if you read the article the context is clear.

Do you believe most 85-year-olds with heart disease are in a hospital and not in public?

Edit: Furthermore the person I replied two defined group 1 as "otherwise healthy". So I think it's fair for me to have inferred they meant what they said and their only other group includes "sick and very sick" people.

Edit2: Realize I had a significant typo. My post was phrased as a statement and not a question. I added the "Do [original]?"

Can’t you be both deaf and healthy? Or missing a leg and healthy? I don’t see how “disabled” implies “not otherwise healthy”.

I often run into people who are deaf, or an amputee, or have type 1 diabetes, etc, but I rarely come across someone that (to my knowledge) has a substantial illness. But I live in a city where I very, very rarely run into someone much over 40 (at that point they are likely to have been married and had children, and the thing nearly everyone does here is move into the suburbs once they’re married with children).

I suspect that where you live makes a huge impact on whether or not you’re surrounded by unhealthy/ill people.

You may not run into people over 40. But most people over 40 absolutely live in ordinary communities.

The original point I replied to suggested everyone at a high risk for bad CPR outcomes is in a hospital. Now we're talking about suburbs.

I think your comment isn't being well received because it represents fairly stark national differences.

In the US, a DNR is primarily for a medical setting with staff who've already identified you and confirmed its veracity. Withdrawing medical care creates massive liability so providers are going to make sure they got it right before stopping. Lay people do not have the knowledge to make these kinds of decisions.

I've never been taught to even check for a bracelet during any of my CPR trainings, and my wife who's been an EMT for 10 years tells me they will still run the code after being presented a DNR until until they receive a clear confirmation from their medical director to cease.

I'm from the US. I've definitely heard US EMTs talk about ignoring DNRs. I think that's pretty unethical.

I was taught in the US to check for a medical ID tag. You've already covered the locations for one bracelet and a necklace during your pulse check. You'll want to know if your patient, for example, caries an EpiPen for a serious allergy.

DNRs are underutilized in the US. As this article points out CPR might not be worth it even if you aren't in hospice care. A DNR would invalidate implied consent so technically doing CPR after seing a DNR tag would be assault.

I think there are really three groups:

1) Healthy people, heart stopped by some traumatic event. Survival odds good.

2) Reasonably healthy people, heart attack. Moderate survival odds.

3) People who were already sick. Odds low, success likely isn't worth it.

not quite - if you stopped breathing, but your heart is working, you have an excellent chance of recovery if someone keeps air going in and out - that’s often the case for children and young people . If your heart stops after trauma, it’s mostly due to something cpr doesn’t address, like severe blood loss, once your heart stops from blood loss, usually your brain is irreversibly damaged in a very short time. The other key group that benefits is people with a “heart that’s too good to die” - meaning a strong heart in a shockable rhythm, in which case cpr may keep your brain alive long enough for someone with a defibrillator to fix the rhythm problem. that’s about 20% of all deaths: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020177/

So probably the optimal message is 1) learn how to do cpr and use it if you ever see someone collapse, but 2) if a doctor suggests that cpr would not be in your or your loved ones best interests, they’re usually right.

I do agree with the author about asking people if they want a “natural death” instead of asking if they want “cpr” or “resuscitation”

For 1), if by "traumatic" you mean "bodily trauma" then it's actually the opposite. If your heart stops due to bodily trauma, it does so as a result of other problems like a lack of blood volume, or something physically impairing your body's ability to oxygenate, none of which are improved by CPR.

The risks and problems are a lot worse for old people than for teenagers. The story in this article is allot more complicated than "Don't try to revive toddlers or always revive comatose 110 year olds". As important as CPR is, people who will be performing it deserve to know 9 out of 10 people will still end up dead. Nobody gains anything from a bystander blaming himself for the death of someone they could never have saved.

For many survivors, life after CPR is a gate worse than death. I'll try to apply CPR should I ever need to, but if I were to end up a vegetable or permanentlysufferimg husk like so many people, I'm pretty sure I'd be begging for euthanasia if I still can.

I may not agree with their decision, but I understand why the nurse in the story may have refused. If I get to live to a ripe old age, I'd get whatever do-not-recussitate paperwork I might need.

> I was dead on the street at 15

Big difference between 15 and 85 or 95.

CPR successfully resuscitating a traumatic arrest is highly unusual. Consider yourself anomalously lucky.

Especially CPR alone. Assuming a defibrillator wasn't used, there's a non-zero chance this wasn't actually a cardiac arrest, but rather a loss of consciousness and the bystander couldn't find a pulse that was actually present (finding a pulse in a high stress situation is not at all easy to do).

I took CPR class quite a few times. One thing I learned, if they are young, there is a good chance it will work. If they are old, there isn't much hope.

As a paramedic, somewhat. It's also to do with how -quickly- CPR starts. What -typically- happens (though by no means always) is the heart goes from a normal sinus rhythm to VT (ventricular tachycardia) to VF (ventricular fibrillation) to asystole / PEA (pulseless electrical activity) or similar.

Now by all means getting ROSC (return of spontaneous circulation) back doesn't mean everything is golden (indeed many patients re-arrest between home and the hospital), because we haven't fixed the underlying cause (plaque in the arteries, etc.)

But similarly, many younger or young adult arrests are often due to congenital defects or issues, diagnosed or not. We obviously don't fix that in the field either.

Where your statement is definitely much more true is in pediatric arrests. The vast majority of pediatric arrests are respiratory arrests that deteriorate into cardiac arrest - be it FBAO (foreign body airway obstruction), near-drowning, or similar. If we can fix the root problem - dislodge that foreign body (either by removal, or from the force of compressions), or at least allow enough air through, either naturally or by ventilation, to get to the lungs and re-perfuse the blood, we can usually get ROSC and, because we -have- "solved" (temporarily or otherwise) the root cause, those patients, thankfully, tend not to re-arrest.

CPR saved my dad's life as well

Successful resuscitation after traumatic arrest is extremely rare. It is more rare than bystander field CPR administered to those that are not in actual arrest (unconscious but with a perfusing rhythm).

What was the confirmation of arrest? I have been called numerous to bedside for in hospital "arrest" that turned out to be assessment error - that is with trained medical professionals.

The value of CPR by is rarely derived from successful resuscitation. In most cases, the person performing CPR is someone who was trained briefly on chest compressions and mouth-to-mouth which to be performed until a EMT arrives or an AED becomes available. The purpose of this procedure is to get some, however small, bit of oxygen into the patient to prevent brain damage.

Trauma arrest has a particularly low survive-to-discharge rate so you beat the odds. Speaking as an EMT, we will make every effort anyways - we like beating the odds too!

I took a rescue diver certification course and after they went through lots of procedures for how to rescue someone, perform CPR, etc and drilled you in varying ways about it, at the exact end of the course they level with you and say the odds of someone actually recovering from these kinds of dive accidents is dismal. Don't beat yourself up if your patient doesn't survive, you tried your best :thumbsup:

I agree these interventions are worth trying but it's definitely important for first responders to be realistic about the success rates so that they aren't haunted by the failures.

CPR shouldn’t work on someone dead from a traumatic injury. For example chest compressions will only hurt someone dead from having their chest crushed against a steering wheel in a car accident. What happened to you is a true miracle and far outside the norm.

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.

Just one of many reviews on this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129833/

Would it make sense for households with those at risk of heart attack to invest in an AED?

Even better is installing an implantable cardiac defibrillator (ICD) in those at high risk.

> at high risk.

Before an event? I’m not sure what insurance would cover this. I don’t really want open heart surgery before I need it.

Plenty of insurance plans cover ICD implantation because it is recommended by the American College of Cardiology for specific situations:

1. moderately to severely reduced systolic function of the heart due to a heart attack that persists > 40 days after the heart attack

2. severely reduced systolic function of the heart of any cause that does not improve after 3 to 6 months of pharmacologic therapy

3. personal history of sudden cardiac death with a persistent risk factor

ICD implantation is not open heart surgery. It is a relatively quick procedure that is done by a cardiologist rather than a cardiothoracic surgeon.

> personal history of sudden cardiac death with a persistent risk factor

Personal history, or family history? Maybe this is a technical term? As a non-medic I can’t imagine there are many people who have a history of sudden death AND a persistent risk of it happening again.

Personal history.

"Many" is relative. We are talking about a fraction of a percent of the general population, but if you are looking specifically at the population of people who have some form of long standing heart disease, it's not terribly rare. I don't work in cardiology specifically, and even so I encounter one or two patients a year who have had an ICD placed for reason #3.

Persistent risk factors include things like or overgrowth of muscular heart tissue (which has dozens of causes, but the most common is severe, long standing coronary artery disease) or scarring of the heart after a heart attack.

Persistent risk factors are not rare at all. The thing is that most people who fall into bucket 3 also fall into buckets 1 or 2. So in an ideal world they would have already seen a cardiologist and had an ICD placed before they ever had an episode of SCD. And of course many of those who do have SCD don't survive long enough to have an ICD placed.

If you are interested in reading more, you can search for "secondary prevention of sudden cardiac death" or "secondary prophylaxis of sudden cardisc death." There are some good review articles available online.

The most common cause of sudden cardiac death is blocked left anterior descending artery.

Generally this is unknown until it happens.

It kills 250,000 Americans every year.

It would make the most sense for people above 50 with a family history of heart disease to have a CT coronary angiogram or for those above 40 to have a Cardiac Calcium Score to risk stratify for future CTCA.

Distributing AEDs is infrastructure heavy and indiscriminate because you don’t know who actually needs one.

Well as long as it only kills Americans, then the simple solution is to emigrate /s

Quite a lot of people/families can find £500-1000 for something important. The more that can, the cheaper it will become.

AEDs/Defibs are just an expensive battery powered thing, that we just don't bother to discuss. With around an hour or less training, you can expect to be at least 10x more effective than the best CPR. CPR is horrible to deploy and very complicated but I will if I have no choice.

They’re not equivalent though! An AED means your heart muscle has been absolutely trashed and will never be the same again. Plus, there’s still the issue of who actually needs an AED in their house, and if you know that, they’ve probably got an IED.

Whereas if you can for the same cost have a scan after being reviewed appropriately, you can avoid the heart muscle trashing. That is nothing short of a miracle in terms of the extension of lifespan available

can you provide sources for AED trashing the heart muscle ?

In the UK, in addition to what the sibling comment mentioned about phone boxes, a lot of workplaces now have AEDs on site (eg I know mine does) and they're also common at large-scale events. I don't know if there are any statistics on how much good they've done but that seems like quite a sensible approach to me as you can presumably get quite a lot of population coverage quite cheaply.

By contrast, a CT coronary angiogram I suspect is rather more resource heavy - in particular I suspect having enough qualified cardiologists to interpret the results (not just having CT machines and staff to administer the test) might be a bottleneck (anecdotal, but having had one myself due to family history of heart disease, I had a longer wait for results after the scan than to get the scan itself).

It’s risk stratification vs preventative care. You don’t WANT someone to have a heart attack and require the AED, because you’ve only got a 5-20% chance of making it out of hospital.

These things are not équivalant!!!

Risk stratification for AEDs at work and public events, whereas screening should increasingly be part of the plan particularly if you have a family history (defined as 1 or more relatives who died younger than 65 from a heart attack)

CTCA doesn’t require a cardiologist, just a radiologist, but a cardiologist referral makes it free (in australia) otherwise it’s $500. Which is pretty good really

There's a cardiologist dark joke about this.

We should be sending ~10 million more patients to the cath lab prophylactically to get a baseline.

At $1k, it’s not a no-brainer, but it’s also not that expensive in the context of the risk it counters.

More important: Call 911 and start CPR. 911 will always bring a defibrillator.

They are about $500 on the cheap end if I'm not mistaken.

I would say yes. Some of the answers here are referring to population stats and you are worrying about your particular circumstances, which is different.

If someone you come across (family, stranger, whatever) keels over you need to, without proper medical knowledge, diagnose the issue and then administer appropriate treatment. Oh and could you do it within a couple of minutes please.

CPR should be a last resort - it can be rather barbaric. A defib has a way better chance of success and won't break your ribs.

A defib costs around £1000 or so. Hopefully that money is wasted.

Generally not, for two reasons.

Firstly, the people most at risk of cardiac arrest are unlikely to regain any meaningful quality of life after resuscitation. An AED might bring a very elderly and/or very ill person back from the dead, but more often than not they'll be just barely alive afterwards, which is not an outcome that most people would choose for themselves. People who are close to the end of their natural lives would benefit much more from serious conversations about end-of-life care than expensive gadgets and false hope.

Secondly, most of the risk of cardiac arrest in younger and relatively healthier people is preventable. If you're not a frail elderly person but you consider yourself at risk of cardiac arrest, it's very likely that you're at least one of: obese, sedentary, hypertensive, poorly-managed diabetic. Before you go out and buy an AED, give some serious thought to what kind of state you'd be in after surviving a cardiac arrest and to whether you'd rather take meaningful action to improve your health now.

Some people with cardiac abnormalities might be good candidates for an at-home AED, but they'd generally be better candidates for an ICD. A young and otherwise healthy person with a condition like LQTS, Brugada or severe HCM is at very real risk of sudden cardiac arrest, but the most likely trigger for that arrest would be strenuous physical exercise - something that most of us don't do in our own homes.

"only as a bridge to using electricity"

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.)

> (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.)

The problem is that this advice is situational.

If electrocution is what caused the cardiac arrest, it is much better to give breaths than compressions. The heartbeat system resets itself before the respiratory system. The problem is then that the heart is back, uses up all its energy reserves, but there is no oxygen to replenish and the heart goes back into arrest.

> If electrocution is what caused the cardiac arrest, it is much better to give breaths than compressions. The heartbeat system resets itself before the respiratory system. The problem is then that the heart is back, uses up all its energy reserves, but there is no oxygen to replenish and the heart goes back into arrest.

Can you provide a reference or citation to this claim and practice?

It is always much better to give "conventional CPR" (breaths and chest compressions) if suitably trained.[1] If not suitably trained you are more likely to a) perform CPR and b) do it effectively if not providing mouth to mouth breathing.[2][3] You can argue about the nuance of particular patient groups where there is potentially a statistically significant benefit of providing conventional CPR over compression only.

Under no circumstances are there benefits to providing rescue breaths without chest compressions (as your comment seems to recommend).

[1]: https://pubmed.ncbi.nlm.nih.gov/21273279/ [2]: https://pubmed.ncbi.nlm.nih.gov/7726702/ [3]: https://pubmed.ncbi.nlm.nih.gov/17420082/

I think it was a while ago down a rabbit hole from the "Kiss of Life" picture talking about respiratory arrest. However, I can't find a substantiated source anymore so I will absolutely defer to your sources.

As far as I can tell, many modern CPR classes dropped the breath part. Just focus on the chest part.

Sort of. CPR classes are divided into, at least, "CPR" and "BLS". Your basic CPR class may be a hands-only training, but the BLS classes still include rescue breathing and AED use, along with infant care.

Took a BLS course in the last year in the US (PNW)... they barely covered breathing. I'm not actually sure, from taking it, when I would do breathing. They did a lot on the AED. I should re-watch the video.

Ah. I have a current AHA BLS cert. My understanding is, do breathing if you think there is a clear airway, and you have the appropriate PPE depending on the fluids on/around the person's mouth, and either you are doing compressions because there is no pulse or there is a pulse but the person is not breathing on their own. If you do choose to do rescue breathing, it's important to watch for chest rise to ensure that you're not breathing into their stomach, which is ineffective and will induce vomiting if the person regains consciousness.

There is a decision tree there that some people may be uncomfortable with in an emergency.

I welcome corrections from people with better training than mine.

I renew my AHA BLS cert every other year as a requirement for my EMT certification. You do breathing when you have a second rescuer available to do compressions.

I just did my cert in the PNW this month - there was plenty of time spent on breathing, but also emphasis that doing compressions is the important part. Interestingly, the instructor thought this change was mostly due to amateurs being far less comfortable with giving breaths and being likely to refrain from CPR altogether if they thought it was necessary to do the breathing.

FWIW I have done it by video during covid and in a live class before and after, and I did find it much more engaging and memorable in person. It was surprising to realize that, but simply having the additional sense memories seems to have made a big difference to retaining the information.

What's the fastest way to find the nearest AED?

At least where I live, it's a requirement in order to operate a business. If you go anywhere and ask for their AED and they don't have one they can be shut down.

In the UK, many old phone boxes have been converted to house defibrillators:

[0]: https://www.independent.co.uk/news/uk/home-news/red-phone-bo...

[1]: https://www.communityheartbeat.org.uk/convert-phone-box

There's an app for that: https://www.pulsepoint.org/download

Depending on your country the GoodSAM app potentially has good mapping/coverage of AED locations: https://www.goodsamapp.org/aed

In most countries, by asking the emergency dispatcher when you call for an ambulance. Start chest compressions, get someone to call for an ambulance, then worry about finding an AED.

> 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.

AEDs are specifically designed to be used by untrained people.

Don't bother doing anything with ventilation unless it's a pediatric patient who arrested specifically because of an airway issue (foreign body, near-drowning). We (EMS) will ventilate with high flow oxygen and intubate on our arrival, but even for us, it still comes a distant second to compressions and electricity.

With adults, blood can remain sufficiently oxygenated for cellular respiration/metabolism for about 8 minutes of compressions. Survival rates for adult CPR as a rough average go down about 10% for every minute of compressions required.

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.

Glad you said this. I have delivered cpr twice: once to my lecturer at school, the other to a stranger in the street. Both times they died. The experience of seeing people freak out when they saw their loved one dying completely devastated me out. Still now the memories are painful.

I told my father, who worked in medicine. He recommended that unless there was a defibrillator nearby, I walk away next time I see someone having a heart attack.

Just to be clear, a "heart attack" commonly refers to a myocardial infarction (part of the hear tis being deprived of blood, generally due to an obstruction in a coronary artery). Someone in the early stages of a heart attack will generally (but not always) experience chest pain/etc, anxiety, shortness of breath, etc.

A heart attack can lead to cardiac arrest, where the heart stops beating effectively and the patient loses consciousness. Cardiac arrest is the scenario you're talking about (where CPR is indicated)

Thanks for the clarification.

TLDR:

1. AEDs should be everywhere.

2. CPR isn't perfect but it works sometimes.

-----

1. Get an AED if you can and keep it near your home and/or vehicle.

2. Just don't expect complete recovery miracle revivals like the movies.

> So yeah, CPR is great but if you don't also have an AED, it's just theater.

There’s at least one scenario where this is less true: drowning. An otherwise healthy person, pulled promptly from the water but not breathing, has a chance of being revived with CPR.

There are a lot of drowning situations where an AED or EMT are far away, and CPR should definitely be attempted.

True. And drowning is one of the few CPR scenarios where early ventilation may be more important than early chest compressions. Follow medical direction and local guidelines to be sure.

If it's just theater without an AED then why was it done before the AED came about?

Manual defibrillators have existed decades longer than automatic ones. Even without an AED immediately available, CPR is useful as long as someone has activated EMS (i.e. called 911). EMS always carries a defibrillator (whether automatic or manual) and CPR buys the patient time until EMS arrives.

My point more precisely should have read "CPR with no possibility of prompt defibrillation is mostly theater."

Same here. And yup. Early effective compressions and early access to defibrillation.

"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."

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.

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.

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.

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.

But there is so much money to be made on the heroic measures front!

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.

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.

It's really unfortunate that we're socially very willing to let people suffer if that's the status quo, but helping someone end their suffering is considered horrible and is in many cases criminal.

Just look at the recent online discussions around the MAID program in Canada. It's meant to be a compassionate end of life for people who have lost all hope, and people are twisting it to mean that Canada is just going to start euthanizing people instead of providing healthcare.

Yeah.

Homelessness: "Personal issue." "Not our problem." "It's you're fault for being junkies and crazies and has nothing to do with the general lack of affordable housing."

Incurable torturous medical stuff and want it over with: "No mercy for you. Heroic measures every step of the way until the bitter end."

It's sadistic.

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?

> 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.

When I was thought it, it was clearly pointed out to me that chance of survival is ~5%, but increases significantly if an AED can be used in time. I've also been told about the rib cracking etc. Just as a counterpoint.

What use is this information though to someone performing CPR? It’s important in the sense that maybe better techniques can be developed but if I need CPR it doesn’t matter one bit if the person doing it knows it’s success rate. In fact probably better they don’t know. If they know the odds are low perhaps they’ll give up too soon.

I could see an argument that knowing the statistics could help the CPR-giver in the aftermath. After all the patient is very likely to die and if the CPR-giver was under the impression that it is likely to work, then they may feel a lot of unwarranted guilt.

> What use is this information though to someone performing CPR?

Possibly quite important to their psychological condition afterwards, given what the very low effectiveness means.

To absolve themselves of guilt and self-doubt.

Someone who doesn't know that CPR has a very low success rate might perform CPR on someone that ends up not surviving and feeling guilty and full of self-doubt, thinking they performed CPR incorrectly.

There was a Reddit thread from someone who had spent years feeling that exact guilt for not saving her grandma https://www.reddit.com/r/BestofRedditorUpdates/comments/102k...

I know a dude who's a very competent ambo, he saw a man collapse and immediately rebooted his heart with a single perfect strike to the chest.

Beyond the prior state of the patient, technique can actually matter as well - but the fact is that the vast majority of people are never going to develop skills beyond "ah ah ah ah staying alive".

Sounds like he administered a precordial thump.

I was taught it was not terribly effective except in case of lightning strike. We weren’t taught how to do it in Mountaineering-Oriented First Aid because of that, and because the leadership, wound care, trauma, and specific conditions aspects of the course took almost the whole three days.

CPR is particularly unlikely to be life-saving in a wilderness scenario (like mountaineering) because professional medical care may be many hours away. Even if you can get a patient's heart restarted with CPR, they may not survive to reach a hospital.

The article links a source and says "In real life, people similarly believe that survival after CPR is over 75%"

The real problem with the article is that it's conflating two things: the absolute rate of survival for cardiac arrest after CPR, and the relative rate of survival for cardiac arrest after CPR (versus doing nothing).

> In real life, people similarly believe that survival after CPR is over 75%.

I'm just a medically ignorant rando, my naive guess was that people survive cardiac arrest without intervention 30% of the time (per the article, the actual rate is 7.6%). Unless you measure people's beliefs about this, you won't be able to determine whether 75% is a good rate or a bad one.

Apparently bystander initiated CPR, out of the hospital, increases those odds to 10%. That means that a third more people will survive if bystanders initiate CPR. That seems ... really good to me? In the hospital, survival after CPR goes up to 17%, which is an increase of 2.2 times! It's actually pretty comparable to someone having naive guesses of 75% CPR survival vs 30% without CPR. (My actual guess was that CPR made a difference about 20% of the time, so all these numbers are way better than that.)

I guess we’re in a state where any reporting is meant to change behaviors?

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.)

This was true in a recent Swiss training as well.

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.

> (although now I'm curious how those odds change when an AED is available)

AEDs are fucking magical.

They even talk to you to tell you how to use them.

If the need arises, get the AED and get going.

Isn't an AED only useful for tachycardia? I'm case of drowning, heart attack, or most other causes of a stopped heart, it isn't useful, correct?

The AED does not restart hearts, it can't do that, the shock disrupts an abnormal rhythm, allowing the restart to potentially take place automatically. But if your heart has actually just outright stopped, you are basically dead.

Clinicians report as little as zero success for patients in asystole (ie their heart has plain stopped). Some studies report a little higher, but it's also possible those rates are mistaken diagnosis, ie you see a flat-looking ECG, you treat anyway, maybe 1% of patients survive - but maybe that 1% were actually not really in asystole.

If you have a heart attack, both an AED and CPR are inappropriate, your heart is still working it's just that the blood isn't going where it's needed. You need immediate medical treatment. While an actual cardiac arrest (which would warrant an AED and CPR) is much more likely during a heart attack, it is not inevitable and these treatments are not prophylactic. Meanwhile your focus needs to be on alerting other people to your problem, so that they can get you medical treatment, and if you do go into cardiac arrest they can perform CPR or use an AED once that becomes appropriate.

> you see a flat-looking ECG, you treat anyway, maybe 1% of patients survive - but maybe that 1% were actually not really in asystole.

Isn't that basically the no true Scotsman fallacy?

False positive paradox.

Maybe?

Sometimes, when our measurements differ from what we can explain with our understanding of the universe, that's because we didn't understand the universe properly. If you put the Sun in the middle, your model of the solar system is still weird nonsense with planets on their circular orbits needing to swing backwards or accelerate forwards for no reason - until you make the orbits ellipses instead and then it's almost like fucking clockwork.

But sometimes, you were just right, and the measurements were off a bit, and there was no real physical phenomenon, you were just bad at measuring.

So, maybe sometimes the human heart does actually stop, yet it can successfully be restarted and then carry on as normal, and the circumstances where this is true are just fairly uncommon and when people are peering very carefully at the results they never ran into one of these rare cases. I cannot rule that out.

> If you have a heart attack, both an AED and CPR are inappropriate

This is a phrase that's easy to interpret in a dangerously wrong way. Here's a clarification:

If you have a heart attack and are still alive and talking, both an AED and CPR are inappropriate.*

If you have a heart attack and die, then both an AED and CPR are very appropriate and might bring you back.

* And even in this case the emergency response medics will put AED electrodes on your chest so it will be ready to use in case you crash.

I think AEDs can also pace these days if it's brady (but not asystole)

I'm not aware of any AEDs that will pace. There are devices that can function as both an AED and an external pacer. Most cardiac monitors used in ambulances have an AED mode that can be used by EMTs, in addition to the more advanced features (transcutaneous pacing, cardioversion, manual defibrillation, etc). Those are the sort of thing a layperson is going to come across as an "AED" though.

Vtach and Vfib are the two shockable rhythms. Those are common in many medical emergencies. Just because the patient doesn't have a feelable pulse doesn't mean they have "flatlined" and don't have a shockable rhythm! You have to put the AED electrodes on their chest to be sure.

If the patient has truly flatlined (asystolic) then shocking them won't bring them back. That only works in the movies.

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.

*illusion (sorry)

I think the risk that people don't even start if they worry about survival rates is higher.

> it won't make things worse

Maybe you should read the article.

One of the preconditions for CPR treatment is that the patient has no heartbeat. The patient is dead, or going to be dead (depending on how you define dead) very shortly without CPR.

So, while the side effects of CPR can be pretty bad, not receiving CPR means guaranteed death.

That's what people mean when they say it won't make things worse.

The article pointed to a study noting that about half of patients who survived wished they hadn't. In other words, they found survival to be a worse outcome than death.

What did the dead people report as their most desirable outcome?

What a strange quote and data point. So 1/4 people didn't want to survive, 1/2 didn't get a chance to choose and 1/4 was happy to survive.

I would recommend reading the article.

Seriously, it's crazy how many people on here clearly didn't read it. I feel like I'm on Reddit. It says specifically:

>In real life, people similarly believe [1] that survival after CPR is over 75%.

[1] https://pubmed.ncbi.nlm.nih.gov/25711518/

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."

Agree completely - in that instance the individual should have some kind of DNR bracelet. That burden falls on the communication of the individual to wear something indicating DNR or requires an assessment at the time by the first responder to decide it isn't worth trying to save the individual and provide comfort instead.

I think that assessment by a first responder is a very difficult decision to put on someone.

>Agree completely - in that instance the individual should have some kind of DNR bracelet.

Even if you wear a DNR bracelet, there's a good chance that it'll be ignored. Bystanders often don't know to look for them and have no legal obligation to abide by them. Healthcare professionals routinely err on the side of caution if there is any doubt about the validity of a DNR order, in no small part because wrongful prolongation of life lawsuits are generally much less costly than wrongful death lawsuits.

Advance healthcare planning is a much more complicated business than simply wearing a bracelet. We need a broad societal conversation about end-of-life care, not least because DNRs are often misunderstood by both patients and healthcare professionals.

I'm offering a simple first step to a complex situation. I don't think the default option is let's not help older people and resort to comfort.

A fun new one I experienced recently when having a minor surgery was having to sign paperwork saying I consented to the doctor ignoring any DNRs, when I asked about it they said it was because if something happened to me while I was in their care it would make their numbers look bad.

And oh man that's a no win if I've ever seen one.

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.

Right. Doing nothing has a near zero recovery rate for cardiac arrest.

Any intervention needs to be judged against the real alternatives and not some imaginary ideal case.

unless we're actively killing more people by doing cpr by accident than would have lived it's a net positive even if it's 1%.

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.

Sure but what if you have a 2% chance of saving them by a thump to the heart, or a 20% chance by running to the store/business a couple blocks away and grabbing their AED.

During that time, a few blocks, they're likely been out for now 2+ minutes or more.

Or you could you know, yell and get other people to call 911 and find an AED.

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.

Maybe dumb question here, but does it at least help to salvage the organs later on (if the donor was okay with it) ?

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.

It’s not that simple. People who do not get CPR live. Others who get CPR didn’t need it. Control group of 0 is missing the complexities of real life.

It is that simple. CPR -- if done properly -- is only done on dead people. Dead people don't come back on their own. And if CPR is done on somebody who "doesn't need it" then by definition it was done wrong, because they weren't dead in the first place.

It will be done wrong, so you have to take that into account.

This is wrong, CPR almost never brings people back.

What CPR does is provide minimal bloodflow and oxygenation until electricity can be used to get the heart beating properly again. By doing this, you extend the window during which an AED (or other defibrilator) can be used successfully and hopefully reduce brain damage in the event of that success.

Indeed, if you have an AED, delaying its use to provide CPR is bad.

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!

Thumpversion sometimes works too. Interestingly it was also invented by Dr. Bernard Lown, who is best known for inventing the DC defibrillator.

It almost never works, unless you are seeing a witnessed cardiac arrest and know how to administer. That is the right ‘indication’ for a précordial thump, but the success rate is still terrible.

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.

Happy to hear you are doing better.

Yep it happened at a boat race, so there were paramedics already on-site. On one hand I was told to avoid competitive-intensity sports in the future, but I was also super fortunate that it all played out at a boat race and not while climbing some mountain. And having the ICD means I can still hike non-strenuous mountains.

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...

You're kinda burying the lede here... Was this woman resuscitated by your efforts and do you know how long she survived afterwards?

*and with what quality of life did she survive?

If I am 85 years old, maybe it is better for me to move on.

CPR + Old Lady + Not in a hospital = Almost certainly didn't survive, or live well if she did.

Yeah, that's what I got from lifeguard training. The best chance of doing anything positive with it is going to be on an otherwise young and healthy person whose heart stopped due to a very unusual trauma.

And CPR and artificial respiration is never a miraculous eyes-opening recovery like in the movies— it's pretty much just putting oxygen in the brain to buy a few extra minutes for the ambulance to arrive and take over.

Correct :-(

I'm sure you did everything you could, the sad fact of life is that eventually it ends.

Ah, sorry! I heard afterwards that she was declared dead when she arrived in the hospital...

I was taught that if you aren't breaking ribs, you're doing it wrong.

I don’t think that’s right. Sometimes the cartilage will break which can sound similar, but broken ribs is a serious condition that can lead to internal bleeding and such.

> Broken ribs are present in 3% of those who survive to hospital discharge, and 15% of those who die in the hospital

https://en.m.wikipedia.org/wiki/Cardiopulmonary_resuscitatio...

Ah, this was something like ten years ago, so it seems likely that I'm misremembering. Thanks for the correction!

I was taught you are supposed to break the cartilage.

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.

https://www.cprcertified.com/blog/can-you-be-sued-for-perfor...

On the other hand: More payouts are made for people NOT providing lifesaving care when they should.

https://newsroom.heart.org/news/legal-risk-of-not-performing...

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 is covered in the article:

>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?

It's unclear what exactly the article is trying to conclude, but it seems to imply there's some agenda to keep doing this technique despite evidence to the contrary - perhaps I should clarify by saying "no medical professional is under the illusion." They know the odds, and have for decades, and it is still recommended training for people, and it should be.

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

Salient data from the article:

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. """

> 'correctly done' chest compressions are extremely violent.

For a good visual of this take a look at a LUCAS machine in operation [1]. I'm a (retained) firefighter and have seen paramedics deploy a LUCAS - it's quite a thing to behold.

> If there's an AED around to use instead that would be FAR more preferable.

Sadly AED's aren't always appropriate. They need a "shockable rhythm" - that is if your heart is in ventricular tachycardia or ventricular fibrillation [2].

One interesting fact I recall reading (source long forgotten ...) is that collapsed women are less likely to be helped with AED's by passers by. This is because they feel uncomfortable uncovering the chest to apply the AED pads.

[1]: https://youtu.be/G-oPJV1LYaE?t=314

[2]: https://www.mayoclinic.org/diseases-conditions/heart-arrhyth...

This is sadly true, a friend and colleague of mine passed away about 7 years ago from sudden cardiac arrest. There was an AED in the building, but unfortunately he was in asystole, nothing there to shock.

Having said that AED's do save a lot of lives, but like CPR they aren't magic.

Holy shit...

I had read that chest compressions for CPR are much more aggressive than people imagine and rips being broken is not uncommon.

The first few seconds of that clip though made me physically wince with discomfort... wow!

This is why you cannot learn CPR by watching people do it on TV. The actor playing dead would be seriously injured if they were receiving proper CPR.

I swear this comes up every 2-5 years. It's insanely violent, doesn't work as well on the elderly (like literally everything else), and is still better than nothing. Things like this almost feel like fear bait. It's intuitive that a procedure performed on someone who's dying is ALWAYS going to be less effective on the elderly. So long as it's not killing more people than it helps (extremely unlikely given the whole "you're not breathing/your heart has stopped" qualifier) it's still an important thing to know.

Quality of life is not a boolean variable. "CPR-induced consciousness" sounds like a truly terrible way to go, and likely to cause real suffering in the practitioner/torturer.

About 93% of the time it's worst than nothing.

The doing nothing treatment leads to death 100% of the time since you don't do CPR on people with a beating heart.

Slightly worse than nothing; saves a tiny bit of exercise for someone. 7% of the time it saves a life.

For bystanders, the raw numbers from the article reflect a 7.6% survival rate became a 10% survival rate. An absolute improvement in about 24 out of 1000 cases, though for those that do 'survive' maybe a 33% increase?

Though those numbers strongly hint at over simplified variables. Is there other medical help available? (E.G. an AED, maybe combined with CPR?) Is EMS close? Are they near a medivac capable landing site and a level 1 trauma center? How does this change across patient demographics?

For my own health, this goes back to end of life management questions, can I recover or even improve to a degree if a procedure is done? As someone with hopefully decades and maybe even a chance at upload or archival if I live long enough CPR probably is worth it for the cases where survival is improved; but only if all the other options are exhausted first.

My nephew performed CPR on my mother (his grandmother). It wasn't successful, he gets to live with the psychological consequences. I imagine not acting would have worse psychological consequences, but only because society has built up unrealistic expectations regarding CPR.

> If there's an AED around to use instead that would be FAR more preferable.

AEDs still require chest compressions. In fact, they'll give you rhythm to follow and talk you through it.

I would expect a very similar rate of injuries from compressions - perhaps a bit less if the AED means the compressions don't need to be performed for the same length of time.

>If there's an AED around to use instead that would be FAR more preferable.

This is dangerously wrong. Availability of an AED does NOT eliminate the need to know CPR.

A defibrillator is useful only for certain types of heart rhythm, namely v-tach and v-fib. It is of no use whatsoever for other rhythms. The AED itself will detect the type of rhythm and will only administer a shock if it is indicated. If the AED does not detect a shockable rhythm, the machine instruct the user to perform CPR.

https://www.proacls.com/wiki/acls-algorithms/shockable-rhyth...

Even if an AED is available, it will not arrive immediately. Even a short lapse in chest compressions can cause lasting damage. It is necessary to give CPR for even the few seconds until the AED is connected.

https://www.redcross.org/take-a-class/cpr/performing-cpr/cpr...

If you are ever in the situation, what will you do?

I will certainly peform CPR. Even after reading the article. Why? Most likely the person is dead anyway, no harm done. But if I don't do it, chances are their family sue me for millions. Especially in the US. Unlikely to succeed, but the risk is far from 0. If they win, my life is ruined. I the face of that, I might even consider a settlement for a large sum. Also terrible. So yeah, sorry old ladies.

Such articles, a much as I appreciate the educative effects, could even make this worse, since if it's more widely known then I could get sued in either case. Like, I did CPR, lady dies anyway but there were clear signs that she suffered. Great, now I'll have a lawsuit in addition to the trauma of having crushed the ribs of an old lady.

I'm not really fit enough to compress properly, nor have I been in CPR training recently.

In an emergency my support role would be better spent on comms support or managing other trauma.

Are there any instances of anybody -- outside of medical professionals -- being sued for not administering CPR? I was told no, but that was decades ago.

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.

You can't make dead any deader.

It might work. You may as well give it a shot, if only to say "well, at least I gave it a shot".

Do your best to give their family $200k medical bill.

Or not, if you're not American.

Or prioritize your funds to pay for your healthcare, like most responsible Americans do.

Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall.

What most people do not realize, according to one researcher, is that their health insurance may not be enough to protect them.

https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most...

You can be a very responsible person and still not be able to cover a sudden expense that is a significant fraction (if not a multiple) of you annual income.

Maybe don't live in a country with third-world healthcare, then.

healthcare still costs regardless of who pays for it.

And the countries with the most comprehensive socialized systems also pride themselves on their civic-mindedness, think about others, not just yourself: shouldn't you, out of civic duty, balance trying to save the public money at the same time as you decide whether you save a life?

Why would they get a "medical bill"?

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.

CPR alone is very, very unlikely to reverse cardiac arrest. It's possible your neighbor lost consciousness, but wasn't actually without a pulse, and CPR just woke them up.

I read this brief but powerful related story of compassion and leadership last year and feel like it's worth sharing here:

https://twitter.com/tjwebbmd/status/1557229120131588098 (warning: covers aspects of the death of a young child)

worse CPR doesn't do what people think it does

CPR is not a live saving measure, it's a temporary live extension if it's not followed up with other measurements it's likely to not save a live. And that's assuming it does work, and is done correctly.

but anyway it gives people another chance at live they most likely wouldn't have had otherwise

If your heart has stopped it is generally because you’re dead. It’s not like an arm where it can just break while everything else is fine.

In cases where it has only stopped because of a truly external factor eg drowning then it works but it won’t work if you’re just dying.

My father two years ago had a heart attack and a stroke, I found him and yelled for my mom and sister, then started CPR until the paramedics came. He survived and is doing very well, but it's crazy to think there was only a 10%~ish chance of it working.

Weird way to say that people should talk to their doctors about how they want to die before the time is upon them.

Major problem in the US. See it every day at my job.

in defense of CPR, the goal is not to help someone recover. the goal is to buy time until the real medical professionals can react with real equipment.

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