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Comment by e40 | Hacker News Reader

It's a little surprising to me they didn't even attempt CPR.

Out of hospital CPR has very slim survival chances. Being on a plane will result in at least 30 minutes of CPR even before an ambulance can take over. Chances on surviving that are extremely low. Therefore I can see why the doctor on the plane decided not to perform CPR. I have a medical degree myself btw.

This +10. Out of the 11 out of hospital arrests that I went to as a Paramedic (in a 6 month period), only 1 of them survived.

Ironically, the one who survived was a prisoner who had cut his own throat. He had pretty much bled out by the time we got there, with a tiny little junctional on the monitor. Today he has 0 deficits, and it is like the event never occurred.

Is CPR done on people with wounds like that? I would think the chest compressions would mostly just be pushing blood out, but I guess doing that is better than doing nothing?

The new protocol (at least for military, or at least serious trauma) is to treat massive bleeding above airway/breathing/circulation. I guess what you'd do is have someone applying pressure (or strap an israeli bandage around the neck, but not tightly in a way which would cut off circulation?) while someone else does CPR and then AED. The goal is to never have more than a 10sec break in chest compressions.

Maybe I'm missing something, but even if there's only a 10% chance of survival I'd still want somebody to give it a shot. What is the downside -- somebody has to do it for 30 minutes until the plane lands?

That's 10% for someone who had access to advanced care within a few minutes.

If CPR goes on for more than 10 minutes or so in a non-hypothermic patient (with no other interventions), your chances of survival are basically nil. This is is especially true if you have a limited number of people doing compressions. Effective compressions are extremely hard work, and rescuer fatigue is a huge issue with CPR (we switch every two minutes no matter how 'fine' the person doing compressions claims to be). I doubt you could maintain effective CPR on an aircraft for 30 minutes (I suppose you could get a couple dozen people involved, but that seems unlikely).

If I'm not back in 15 minutes, please stop... At that point enough damage has been done to my brain that I don't want to come back...

Depends where you are - In the area around the Mayo Clinic in Minnesota, or in the Puget Sound, return of spontaneous circulation rates can approach 40+% for witnessed treatable arrythmias.

Likewise in Pittsburgh, where the paramedics have been given protocols for hypothermia, ROSC outcomes for arrests are much higher than the national average.

My dad had a massive heart attack December 2'nd. My mom and I were at the house when my dad had it.

Having no medical training, I know how to perform CPR and was able to resuscitate him to get to the local hospital and then to Methodist in Indy. Every doctor attributed to him living past 30 minutes to my efforts .

Outlook looked somewhat good for the short term, but the longer he was in ICU his chances worsened. Due to longer term massive organ failure, he passed on 12/12/12. My dad was Wilbur Harold Crawley III: automotive, electrical, and acoustic engineer.

Remember that CPR will not restart a stopped heart. CPR's only use is to maintain some blood/air flow until you can get to a defibrillator or life-support machinery, in hopes of preventing damage to the brain or other vital bits.

And unless it's started pretty much immediately, it won't even accomplish that, which makes it futile.

It won't, but there are several shockable rhythms that present as "pulseless" that can indeed be converted. AEDs will shock VF and VT, and manual defib can help with others.

This type of situation is exactly the reason AEDs are now found all over in public places. Sure, CPR for several hours does not yield positive outcomes. But if this guy is slumped because of a shockable rhythm, that AED in the field is not at all useless - it will likely save his life, and minimize the deficits he experiences afterward. Especially on a plane, where the person was likely noticed down minutes after his problem started.

Or hook up an AED.

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