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Comment by SkyPuncher | Hacker News Reader

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.

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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.

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.

This distinction was my take away from the article.

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.

> 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.

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.

>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.

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