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Comment by jvanderbot | Hacker News Reader

My father didn't die of a heart attack, he died of an aneurysm. However, he had a massive "widow maker" heart attack and had to be revived from arrest in the ER, more than once.

He had a heart beat, unconscious, for a few days, before the blood thinners caused the aneurysm, I'm told.

So, is this a heart attack? Is this "less deadly?" No, it's a proximal classification. Maybe their cardiac care center has a metric to hit.

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Anecdotally I worked in the emergency department and ICU for 2.5 years as a scribe and translator in undergrad (ending about 7 years ago) and never saw a single person successfully revived. In the sense that everybody who ever got revived to the point that your dad did, in my experience, died.

this is why american medical care is so expensive. Family’s and Law make doctors “do everything” even when the doctors know there is 0.01% chance such a person even makes it out of the icu and that’s not saying anything about brain function.

IMO it's still good that it's family's decision. Even if it is an incorrect one.

I think its good, but I also think that we don't have enough education in the US populace about what this means realistically. "Pulling out all the stops" means that your loved ones last time on this earth is either in agony or comatose, neither of which I would tolerate of my dog much less my mother.

Very sadly true. As someone who has done CPR probably 250-300 times, one of the most challenging parts was transitioning to the role where I'm talking to family, and explaining the realities of things, and when we should discontinue efforts.

The biggest reason is probably that you need to fit a medical insurance agent, a lawyer and a doctor all around the same hospital bed to give care.

I'm pretty sure that in "socialized medicine" countries i.e. the rest of the civilized world pretty much, they also "do everything" even if chances are low. AND everyone involved (including family) can do their part in it without having to deal with papers, money, bills, proof of insurance, and the plethora of other likely speed bumps that exist in the US.

So no, I don't think that's why. If anything, the amount and quality of average care for the average US citizen is lower, if life expectancy and my anecdotal observation are valid indicators.

It's expensive because it's a business designed to make profit every step of the way, and over time has created many steps to feed.

Even if they die, reviving them still opens the door for organ and tissue donation.

I'm no expert but at least in the initial stages of resuscitation, the cost is relatively low. Paramedics doing CPR, defibrillation, some epinephrine, then in the ER they'll intubate, get some lines in, push more epi and maybe amiodarone - pretty basic stuff that's more about doing it fast than expensive equipment. I don't think it adds up to a ton… well yes American healthcare is absurdly expensive, but this particular aspect isn't extraordinary. The initial resuscitation steps are about timing, not fancy drugs

Off the top of my mind, I can think of two patients who I personally cared for in the days or weeks after CPR who had an outcome other than death or vegetative state. One patient walked out the door two weeks after admission. The other patient regained consciousness and was able to speak/communicate, but was bed bound, appeared to have sustained some degree of cognitive damage, and had to receive feeds through a gastric tube. She was in the hospital for about six months before being discharged to a nursing facility. That's the numerator. It's hard to quantify the denominator. 40 or 50 maybe? But that's a guess.

I had a patient who checked in the ED for chest pain (felt like indigestion but he was intelligent enough to know it wasn't). Arrested just as we were getting vitals. CPR and shock -> came back awake and asked what happened. EKG after ROSC indicated STEMI. Arrested again, this time we just shocked right away before CPR and he awakened with ROSC. Eventually the cath lab was no longer occupied (this was a small hospital) and he went and got taken care of. Even if he arrested once and awakened it would have been amazing. But twice, I had never seen that in my years working in various emergency departments. That story had a happy ending (or continuation, as life moves on to new seasons), something I don't see very often. Other than that, my experience matches up mostly with yours in that for patients who arrest, happy outcomes are rare. One medic called 911 for his wife who had arrested - luckily he had witnessed it and went straight to the chest while his teammates on duty came to bring her in. I can't remember if they got ROSC or if we did, but she had a fair outcome. She had a long rehab time but was able to live a mostly normal life after that. The ones who just don't have a good ending are too many to count.

Most studies of hospital resuscitation survival puts it at about a 1/4. Plenty of people survive and have good neurological outcomes lots of people do not [0].

Outside of diagnostically defined cohort it’s a bit of a silly idea as you can attempt on anyone without respect to readily identified odds of success [1] so the what of CPR isn’t readily untangled from the who of it.

Out of hospital is a similar story but with less ability to triage and thus the same pattern in which the fact of CPR [2] is less informative than the underlying problem [3, old but the best study I know of would be interested if someone knows of an update to it given in hospital trend since].

0. https://www.nejm.org/doi/full/10.1056/NEJMoa1109148

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC8118500/

2. https://ccforum.biomedcentral.com/articles/10.1186/s13054-02...

3. https://pmc.ncbi.nlm.nih.gov/articles/PMC1767484/

what can happen is something like this

>have heart attack, which is when an artery clog prevents oxygen and blood from getting to the heart

>heart tissue impacted by clogged artery dies

>ED did revive person and get the heart beating again, but the dead tissue is still there and goes through the dying / fibrotic process over several days

>during the process the tissue is in a fragile state, so the heart can rupture

this is how carrie fisher died, a few days after the heart attack, for example

> heart attack and had to be revived from arrest

Worth pointing out that heart attacks and cardiac arrest are not the same. A heart attack (myocardial infarction) is insufficient supply of blood to the heart, which causes damage. Cardiac arrest is when the heart stops completely (and is much more serious).

Heart attacks can cause cardiac arrest (especially if not treated), but the most common outcome is not immediate death. With proper treatment maybe 95% of MCI patients will survive. The prognosis for cardiac arrest is much worse - ~90% of patients experiencing a cardiac arrest will not survive, even if temporarily revived.

Out-of-hospital arrests are that deadly. Those that occur in a hospital are somewhat more survivable.

Not a whole lot more, but if you're going to arrest you want to do it in a hospital with lots of nurses nearby.

Many heart attacks occur because people don't get enough exercise and overeat. This is often the result of clinical depression. Is the killer depression or is it heart disease?

Same with the hyperlipidemia. It leads to eventual plaques in the arteries, which leads to heart attacks. But that's a genetic abnormality in the liver. The liver is pulling the trigger, the heart is taking the bullet.

Preventative care also seems to be an issue. Medicare denied a test for my dad to check the state of his heart, because it wasn't really having any symptoms. When he found out the test was only about $100, he just paid for it himself. He'll be going in for a quintuple bypass next week. I guess Medicare was content to wait for a heart attack.

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