CPR Whats the point

[jameswf]

I don't want to be "that guy" but it's coming.

I am sure the argument can be made anything that saves just one life is "worth it."

I have been seeing that CPR when done properly has about a 3% success rate. So for every hundered people you do CPR on 97 will probably die. They put such an enphasis on everyone and their dog learning CPR with such a high mortality rate. It just all seems like a lost cause.

 

[Handsome Robb]

Is this a serious question?

 

[JPINFV]

The purpose of CPR is not to directly save a life.

The purpose of CPR is to buy time for other interventions (fixing the 5 Ts and 5 Hs, defibrillation, etc) that have a higher chance of saving a life. This is especially true in the time between recognizing a cardiac arrest and obtaining a defibrillator or having EMS arrive.

 

[Veneficus]

I don't want to be "that guy" but it's coming.

I am sure the argument can be made anything that saves just one life is "worth it."

I have been seeing that CPR when done properly has about a 3% success rate. So for every hundered people you do CPR on 97 will probably die. They put such an enphasis on everyone and their dog learning CPR with such a high mortality rate. It just all seems like a lost cause.

What determines life and death is not CPR.

CPR determines whether or not the person has a chance.

There are many studies and statistics on it over the years. It has even been challenged by some very exceptional minds.

The last numbers I have heard is that sudden cardiac arrest is caused by MI about 70% of the time. The number one complication of MI is a lethal rhythm.

Which means that CPR+defib, the proven methods that work, are going to leave behind 30% of all victims prior to their effectiveness.

However, the caviat is "early CPR and defib" which means if it is to be effective, it will be bystanders, not EMS professionals who make the difference.

For non healthcare professionals, it is probably the cheapest and easiest way to learn and make a difference. (since they don't have to recert every 2 years)

But there are many variables that ultimately determine effectiveness.

The time before compressions.
Quality of compressions.
Regional health and wellness levels.
individual comorbidities.

Just to name a few.

If a victim of cardiac arrest has to wait the 6+ minutes for a professional healthcare provider to show up prior to compressions begining, then even 3% leaving the hospital would be a generous number.

Why should it be taught?

It is cheap, can easily be performed, and the more people who know it and are willing to perform it will reduce the time to first compressions thus buying time for ALS intervention, and ultimately definitive care of the underlying cause when possible.

That is what increases survival and justifies its value.

 

[VFlutter]

Do you have a link for that data? CPR is rarely done properly but I think when it is properly done the survival rate would be slightly higher (depending on circumstances). I can say for personal experience the majority of codes that occur in the hospital (people already patients) do have positive outcomes.

And as just said it is all about buying time for definitive treatment and fixing reversible causes.

Why not put everyone that codes on ECMO?

 

[Veneficus]

Is this a serious question?

It is a serious question and one even asked by some very reputable doctors.

We must always question the convention in order to check ourselves and progress.

 

[medicdan]

Agreed. CPR (or associated similar interventions) CAN have decent outcomes, if properly practiced. CCR (hands only), use of a Lucas, team approaches, etc have all been shown to bring survival to closer to 35%, and there is still much more to be done.

Many of our prehospital interventions have been proven to be detrimental or not effective, and especially with CPR, there is constant research and improvement of guidelines and protocol. Look up the current ILCOR/ECC research, and look at Seattle, WA (King County Medics) survival rates.
I'm not advertising these sucess rates broadly, but for those services that really invest the time, research, training, etc.

 

[firetender]

The purpose of CPR is not to directly save a life.

The purpose of CPR is to do something rather than just watch someone die.

Three out of a hundred ain't bad, especially if you're one of them!

 

[jameswf]

Thanks

Thanks for all the feedback.

It was a serious question. I knew it may come across as trolling but had to ask. I have read posts that give the high mortality rate nothing overly official. I watched my neighbor die and he was given CPR (low quality). I hadn't done CPR in almost 20 years and never on a real person. I had considered doing the EMT thing on the path to paramedic for a while and this event inspired me a bit. Nothing like watching someone die and being completely helpless/useless.
So I did my Healthcare provider CPR class (pre-req for the EMT class) and was all gung-ho I am the awesome but then start reading that even with CPR the end result is likely still death. Well that is a way to deflate the sail. So really was looking for some real feedback to know it's worth it. You hear the anicdotes from the CPR teacher but those may just be something they read in a book somewhere and they don't tell you the bad stuff.

 

[VFlutter]

Thanks for all the feedback.

It was a serious question. I knew it may come across as trolling but had to ask. I have read posts that give the high mortality rate nothing overly official. I watched my neighbor die and he was given CPR (low quality). I hadn't done CPR in almost 20 years and never on a real person. I had considered doing the EMT thing on the path to paramedic for a while and this event inspired me a bit. Nothing like watching someone die and being completely helpless/useless.
So I did my Healthcare provider CPR class (pre-req for the EMT class) and was all gung-ho I am the awesome but then start reading that even with CPR the end result is likely still death. Well that is a way to deflate the sail. So really was looking for some real feedback to know it's worth it. You hear the anicdotes from the CPR teacher but those may just be something they read in a book somewhere and they don't tell you the bad stuff.

First of all what do you mean by "worth it"? Worth it to who? If I saw a random person collapsed on the street would I spend the time and energy to start CPR on them? Personally, Yes! They are dead, if you do nothing they are still going to be dead. If you do CPR they will most likely still be dead but at least you are giving them some chance. So if you spend 30 mins doing CPR, what is the end result? You are going to be very tired and probably sore for a day or two, that doesn't sound like much of a cost to me. Worst case scenario you wasted a half hour and got a good workout and did nothing for the patient. But best case scenario you save someone's life.

 

[shiroun]

If a victim of cardiac arrest has to wait the 6+ minutes for a professional healthcare provider to show up prior to compressions begining, then even 3% leaving the hospital would be a generous number.

Just a slight tangent, I believe that the human body is able to sustain life without any extra o2 for around 6-8 minutes* before major brain damage sets in. Heard it in class, may only apply to respiratory attacks though, which might make a bit of sense since in MI patients they mostly have asystole or VFib, and in asystole no blood would be flowing, and vfib would have very little.

If the patients were mostly VFib, they could potentially survive 6 or so minutes if proper CPR and the use of an AED were administered when the EMTs showed up

Thats just my two cents though, correct me if I'm wrong.

 

[medicdan]

Just a slight tangent, I believe that the human body is able to sustain life without any extra o2 for around 6-8 minutes* before major brain damage sets in. Heard it in class, may only apply to respiratory attacks though, which might make a bit of sense since in MI patients they mostly have asystole or VFib, and in asystole no blood would be flowing, and vfib would have very little.

If the patients were mostly VFib, they could potentially survive 6 or so minutes if proper CPR and the use of an AED were administered when the EMTs showed up

Thats just my two cents though, correct me if I'm wrong.

Quick correction... While the research has shown that a paralyzed patient with a good pulse won't drop their O2 sat below 90% for 8 minutes or so, remember their heart is working, and circulating blood to the brain. Early research and anecdotal evidence shows that performing only compressions for those 8 min before attempting ventilator, intubation, etc, we can improve survival-- that's what is called CCR, cardio cerebral resuscitation.

 

[CANDawg]

Just a slight tangent, I believe that the human body is able to sustain life without any extra o2 for around 6-8 minutes* before major brain damage sets in. Heard it in class, may only apply to respiratory attacks though, which might make a bit of sense since in MI patients they mostly have asystole or VFib, and in asystole no blood would be flowing, and vfib would have very little.

If the patients were mostly VFib, they could potentially survive 6 or so minutes if proper CPR and the use of an AED were administered when the EMTs showed up

Thats just my two cents though, correct me if I'm wrong.

I've actually been taught 4-6 minutes before significant brain damage starts to set in. That said, brain cells can start dying in 30 seconds to a minute if deprived of oxygen.

 

[OIFXGunner]

I wish I had a link to post, but in Richmond they've been running trials with therapeutic hypothermia in the field and they've been having some amazing results with survival-to-discharge statistics. Of course that's post-resuscitation care, but the biggest thing that they have going is their quick response times. I'll see if I can find some literature on the study.

 

[medicdan]

I wish I had a link to post, but in Richmond they've been running trials with therapeutic hypothermia in the field and they've been having some amazing results with survival-to-discharge statistics. Of course that's post-resuscitation care, but the biggest thing that they have going is their quick response times. I'll see if I can find some literature on the study.

Post ROSC cooling has become standard protocol in MA because of the promising results... and is one part of the greater science improving survival rates. In EMS we've gotten good at getting more patients to the hospital with a pulse, the idea with this is to get more of them to survival until hospital discharge.

 

[STXmedic]

Post-ROSC hypothermia is fairly standard and accepted now, depending on your area and hospitals. Some systems (mine included) are participating in trials for inta-arrest hypothermia. n=1 here, but I've used it twice so far, and both were legitimate saves with good neuro recovery per hospital. Now whether that's just luck, or can be contributed to the early hypothermia, I will not speculate.

 

[phideux]

I've initiated CPR 3 times in the last few months, 1 made it back to normal with no deficits. So personally I can tell you there has been a 33.333% success rate when CPR is initiated. To me it's "worth it".

 

[OIFXGunner]

Post-ROSC hypothermia is fairly standard and accepted now, depending on your area and hospitals. Some systems (mine included) are participating in trials for inta-arrest hypothermia. n=1 here, but I've used it twice so far, and both were legitimate saves with good neuro recovery per hospital. Now whether that's just luck, or can be contributed to the early hypothermia, I will not speculate.

Around here it's just beginning to make its way into the field, so it's relatively new and shiny for us. Most of our local hospitals are using it (at the minimum initiating it on good candidates prior to transferring them to a cardiac center) but only two EMS agencies are using it to my knowledge. I'd be interested to see some of the numbers on intra-arrest hypothermia. The theory makes good sense, at least.

 

[Skittles]

If I remember correctly from when I was in school to be an MA, your body only utilizes 17% of the oxygen that you take in. So when you exhale, you would also be exhaling 83% of the oxygen you took in in the first place. Therefore, when you give the two rescue breaths, there would be utilizable oxygen. And compressions when done properly, massage the heart and keep the blood moving, even if slower than normal. So the oxygen provided in the rescue breaths along with the compressions to help move the blood through the body would help to prolong cellular life long enough for EMS to get there.

I could be completely wrong, but that is how it was explained to us in class. And, if this is true, I believe that it is worth it. You may loose two out of three patients, but you did help to give them another chance at life.

 

[AnthonyM83]

I don't want to be "that guy" but it's coming.

I am sure the argument can be made anything that saves just one life is "worth it."

I have been seeing that CPR when done properly has about a 3% success rate. So for every hundered people you do CPR on 97 will probably die. They put such an enphasis on everyone and their dog learning CPR with such a high mortality rate. It just all seems like a lost cause.

I dunno man. I had a 5 out of 5 return of spontaneous circulation rate a bit ago. Wasn't able to track them out of hospital, but I gave them a chance. Separate from that 5/5 streak, I've had countless others (literally, I lost count...probably in the high teens or lower 20s). One, I even had a conversation with before leaving the ER. Alert, oriented, wanting to leave the hospital, not understanding he had just coded.