CPR Whats the point

[DrParasite]

CPR is maybe 30% as effective as the hearts own heartbeat. It in and of itself doesn't save lives. What it does it extend the time until the fatal cardiac rythym becomes unrecoverable, giving you a couple extra minutes until defib can be applied, which is what you need to get a good rythym.

In 14 years, I have less than a dozen saves, where we found the patient in cardiac arrest and had a pulse when we got to the ER. Maybe 4 walked out of the ER.

typically a save comes with a defib is applied immediately, CPR is applied immediately (followed by a rapid defib), or EMS witnesses it (and defib is immediately applied).

The large majority of patients (both old and young) who go into cardiac arrest won't survive. That's the simple fact. The overwhelming number of people who are transported to the hospital in cardiac arrest won't walk out of the hospital. Also a documented fact.

Life is a fatal condition. 100%. If you have a patient in cardiac arrest who is between 2 years old and 60, the survival chances are pretty good, if CPR (and EARLY Defib) are done (assuming no other complications already exist). under 2 (and not an airway condition, which you need to clear the airway or else all the CPR in the world won't help) and it's probably an undiagnosed congenital condition. After 60 (and the old you get, the lower the chances), you might bring it back, but when you get a save on an 80 year old, did you really save a life? sometimes if it's your time to go, nothing on earth can stop that.

 

[Handsome Robb]

That is what a phone call to medical control is for.

This is a very good point.

 

[OIFXGunner]

That is what a phone call to medical control is for.

If the patient presents in a manner consistent with cease resuscitation. However, beyond medical reasons, it is not our place to decide that someone should not be resuscitated.

 

[Bullets]

If we really wanted to follow the bouncing ball, the better question is why do we do ACLS, compressions and electricity are being shown to be the most effective treatments, ACLS is being shown to be at best ineffective and at worst actually harms the patient

 

[Handsome Robb]

If the patient presents in a manner consistent with cease resuscitation. However, beyond medical reasons, it is not our place to decide that someone should not be resuscitated.

So you have a family telling you that the patient doesn't want to resuscitation efforts however the paperwork hasn't gone through yet, are you really going to pull out the cannon and disregard the family or are you going to do BLS and make a phone call?

Just one example that's a pretty common occurrence.

 

[Veneficus]

If the patient presents in a manner consistent with cease resuscitation. However, beyond medical reasons, it is not our place to decide that someone should not be resuscitated.

I am not sure what you mean by this. Is there a reason outside of a medical you would not initiate efforts or cease resuscitation?

 

[Christopher]

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.

"Worth it." It is a little jarring to hear CPR phrased like that.

In areas which treat cardiac arrest appropriately, it isn't 6% which survive but 15-20% that survive intact. This is an all-comers approach too, so it isn't a number which is cherry picked.

Better yet, if you start CPR when you see a victim collapse, some areas will send you home 50% of the time (or better). I know my service area does.

If you're looking for what's "worth it", there are three interventions which have been proven to improve survival to discharge neurologically intact:

1. Continuous, uninterrupted chest compressions
2. Early and appropriately timed defibrillation
3. Therapeutic hypothermia

Do these three and you'll make a real difference.

 

[OIFXGunner]

So you have a family telling you that the patient doesn't want to resuscitation efforts however the paperwork hasn't gone through yet, are you really going to pull out the cannon and disregard the family or are you going to do BLS and make a phone call?

Just one example that's a pretty common occurrence.

Absolutely I'm going to disregard the family. It might be entirely true that the person did not want to be resuscitated, but from a legal standpoint, if they were truly serious about not being resuscitated, they would have a DNR in place. Anything short of a valid DNR,a valid medical power of attorney, or obvious medical indications for ceasing arrest, and I'm resuscitating the patient. It's always better to err on the side of saving someone's life as opposed to letting someone die who might possibly have wanted to live.

I am not sure what you mean by this. Is there a reason outside of a medical you would not initiate efforts or cease resuscitation?

I've run into several medics who have either called for cease resuscitation or have basically resuscitated half-:censored: because they felt that the person's quality of life was bad enough that the person should just be allowed to die without a DNR, medical power of attorney, or medical indications for ceasing resuscitation. Your comment about allowing them to have "a peaceful end" reminded me of that. I'm in no way saying that it's something that you specifically would do, but that's what it reminded me of.

 

[Aidey]

Absolutely I'm going to disregard the family. It might be entirely true that the person did not want to be resuscitated, but from a legal standpoint, if they were truly serious about not being resuscitated, they would have a DNR in place. Anything short of a valid DNR,a valid medical power of attorney, or obvious medical indications for ceasing arrest, and I'm resuscitating the patient. It's always better to err on the side of saving someone's life as opposed to letting someone die who might possibly have wanted to live.

Correction, you're going to try to resuscitate the pt, chances are good you're not going to get anywhere.

Now repeat after me, "That is what medical control is for". Seriously, I've run into this a few times, where the DNR is missing a signature, or it is in the wrong spot, or not dated. We call medical control, explain the pt is dead, they have a DNR with an error on it, and family is saying no CPR. I have yet to have a doc tell me to resuscitate.

 

[OIFXGunner]

Correction, you're going to try to resuscitate the pt, chances are good you're not going to get anywhere.

Now repeat after me, "That is what medical control is for". Seriously, I've run into this a few times, where the DNR is missing a signature, or it is in the wrong spot, or not dated. We call medical control, explain the pt is dead, they have a DNR with an error on it, and family is saying no CPR. I have yet to have a doc tell me to resuscitate.

There's a big difference between a DNR with an error and a patient who doesn't have a DNR. You're talking about two entirely different situations.

It's a lot easier to defend your position in court for attempting to resuscitate a patient than for withholding resuscitation efforts.

 

[Shishkabob]

I have been seeing that CPR when done properly has about a 3% success rate.

Until you get to such places as mine where there's an ~7% survival-to-discharge with good neurological outcomes, and there are systems with better than that.

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.

Why even do medicine at all? Everyone dies at some point, right?

 

[OzAmbo]

Until you get to such places as mine where there's an ~7% survival-to-discharge with good neurological outcomes, and there are systems with better than that.




Why even do medicine at all? Everyone dies at some point, right?

out of hospital cardiac arrest management here is achieving a 50% ROSC and 30% survival to discharge, most of which has been achieved through early access to CPR and defib by a first responder system, the remainder by aggressive management of B/P post arrest, RSI and then therapeutic cooling

 

[STXmedic]

What parameters are you using to get those numbers? Many places here use the exact same strategy as yours, with similar results as Linuss.

 

[Christopher]

What parameters are you using to get those numbers? Many places here use the exact same strategy as yours, with similar results as Linuss.

~15% all rhythms, ~60% Utstein (4 months under new system).

• Continuous uninterrupted chest compressions
• Delayed advanced airway (either BVM or NRB to start, King/ETT after) for 3 cycles
• "Pit crew" rotation of compressors
• Precharging defib
• 5 second interp/shock pauses
• IO access first line, IV secondary
• Standard ACLS meds (epi, amio/lido, mag/calcium/bicarb)
• Therapeutic Hypothermia (one service is post arrest, one is intraarrest)

 

[VirginiaEMT]

I actually asked a question similar to this in EMT-I class because it sure seemed like we spent a lot of time on something that usually does not have a good outcome, when we could have spent many more hours on topics that were actually of far greater benefit, at least that is what I thought at the time. The one scenario that is used to release an EMT-I/99 provider is the mega-code. Wouldn't it be of greater benefit for a provider to know more about acidodsis, hyperkalemia, crush injuries and compartment syndrome, MI's, EKGs, pediatrics, etc. instead of spending so much time on how to work a code?( I could use any example here) There is only 2 stations at the NREMT-I that involves pediatrics and those were airway and I.O.

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.

 

[Veneficus]

I actually asked a question similar to this in EMT-I class because it sure seemed like we spent a lot of time on something that usually does not have a good outcome, when we could have spent many more hours on topics that were actually of far greater benefit, at least that is what I thought at the time. The one scenario that is used to release an EMT-I/99 provider is the mega-code. Wouldn't it be of greater benefit for a provider to know more about acidodsis, hyperkalemia, crush injuries and compartment syndrome, MI's, EKGs, pediatrics, etc. instead of spending so much time on how to work a code?( I could use any example here) There is only 2 stations at the NREMT-I that involves pediatrics and those were airway and I.O.

If you cannot keep a patient alive while you figure those things out, what good is knowing about them?

 

[VirginiaEMT]

If you cannot keep a patient alive while you figure those things out, what good is knowing about them?

good point

 

[Sandog]

good point

You caved so easily

 

[VirginiaEMT]

I was in a hurry and didn't have time for a rebuttal. LOL!!

You caved so easily

 

[NYMedic828]

Literally had a ROSC 5 minutes ago.

CPR 30 minutes, shocked v fib 7 times.

On her way to cath lab now.


CPR was started immediately upon arrest.

CPR obviously works...