I don't think anyone is under the allusion that CPR has like a 95% success rate do they?
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.
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.
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.
Isn't that basically the no true Scotsman fallacy?
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.
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.
If the patient has truly flatlined (asystolic) then shocking them won't bring them back. That only works in the movies.
> 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."
I think that assessment by a first responder is a very difficult decision to put on someone.
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.
And oh man that's a no win if I've ever seen one.
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 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.
Possibly quite important to their psychological condition afterwards, given what the very low effectiveness means.
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.
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".
Any intervention needs to be judged against the real alternatives and not some imaginary ideal case.
>In real life, people similarly believe [1] that survival after CPR is over 75%.
> 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.)
Transparency is a small kindness to help the people who do CPR not beat themselves up when it (probably) fails.
*illusion (sorry)
Maybe you should read the article.
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.
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.
Or you could you know, yell and get other people to call 911 and find an AED.