CPR is a good thing and hopefully this article will not make people think twice before administering it.
* 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.
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.
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.
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.
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]?"
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.
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.
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 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.
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.
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”
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.
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.
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...
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.
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?
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 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.
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.
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.
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.
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.
Big difference between 15 and 85 or 95.