CPR and other stuff and survival rates

I am reminded reading http://www.straightdope.com/columns/read/2890/has-widespread-cpr-training-resulted-in-more-lives-saved that we hear a lot of stuff like ‘learn CPR’, ‘call 911’, ‘wash you hands’ that may or may not be helpful. They are rather like ‘pray’ or ‘do something’. I am reminded of the ‘curl up under your desk in case of a nuclear attack’ or the cases in the old Western movie when some poor woman was giving birth in a sod hut and someone commanded ‘go boil some water’.

I believe all of your examples are, in fact, useful. Maybe not all the time, but there are more than enough situations in which they’re useful to be worth recommending.
Powers &8^]

Anecdote 1: my dad (who is not a doctor, EMT, lifeguard, etc) once gave heart stimulation to someone having a heart attack. This was in the 60s, when it wasn’t modern CPR. (Didn’t do any good.)

Anecdote 2: 10 years ago a man at work had a heart attack in a meeting. Someone started CPR, they called an ambulance. He is still alive.

Is CPR always going to work? No. Can it save lives? Yes. How likely is it to help? It really depends on how quickly it is started, and how quickly the person receives further medical attention, and how severe the heart attack is.

Youre first three examples are all equally misapplied. No intervention is going to have a 100% survival rate.

When you consider what CPR is attempting - keeping an technically dead person alive - even a 4% improvement is nothing to sneeze at. That said, Learn CPR is a Good Thing, since it is effective if started soon enough and performed properly.

Similarly, why in the world would “call 911” be an ineffective thing to do in a crisis? At the very least, you’re going to summon people that are trained to deal with the crisis. If the dispatcher is incompetent or the situation beyond the abilities of the first responders, that doesn’t change the fact that this one of the best responses of untrained laypeople.

Your examples are not remotely in the same category of the 50’s “Duck and Cover” drills.

The thing is, lots of things cause cardiopulmonary arrest, some are survivable if treated quickly, most aren’t; even professionals often won’t know until they try and resuscitate a person and see how it goes. Sooo, the plan is to throw a lot of bystander CPR at the problem and hope the few that can be saved, are. It’s not like there’s a downside.

Sure there’s a downside.

Lots of expense to train everyone and maintain training so they will be effective.

Stress over people doing something and then finding out that something was worthless/ineffective (in that situation, i.e. the victim dies anyway).

The question is are those downsides significant enough to overcome the upsides. I think so.

Well, I’ll concede the money, but the stess of doing nothing and worrying about what might have been, is equal to if not greater than the stress of trying and not succeeding, IMHO.

My job requires me to (1) be able to perform CPR and (2) be able to instruct 911 callers in how to perform CPR over the telephone (the instruction, not the performance, takes place over the telephone). I hope it surprises no one to be told that the CPR I learned for my certification is a little different than the CPR I coach on the phone. Either way, it’s important to realize that the goal of CPR (excluding use of an available AED) is not to “save” someone in cardiac/respiratory arrest: it’s to keep the body viable (oxygen to the brain) until its owner can be saved via more sophisticated methods, such as drugs and defibrillation.* Depending on circumstances, 911 callers may be instructed to breathe first, do compressions first, or even compress exclusively and breathe not at all. I couldn’t tell you the percentage of cardiac arrest victims who (once we get the call) actually get even an honest attempt at CPR. That, in fact, is the biggest hurdle – the people who call 911 but aren’t even able or willing to try. And I can’t tell you accurately the percentage of the victims who do get untrained but coached CPR who make it, once the responders arrive, to the status of working cardiac arrest (the alternative is DOA), or how many of those get transported, alive, to a hospital for further treatment. I can say that I was surprised at the assertion of paperbackwriter that s/he was an EMT who performed CPR three times, which to me is like a major-leaguer answering a question based on his three at-bats. Of course, I work in an area where CARDAR is a common medical call, and there are plenty of places where it is very rare. No disrespect to paperbackwriter, mind you - I have no quarrel with his/her credentials or her/his research and answer, except that I suspect that regionally results vary widely enough that optimism is always appropriate.

All that said, I couldn’t tell you whether CPR instruction is cost-effective where 911 service is competent to instruct laymen, but I can say that in many places the cost of instruction is borne by the learner, and on an individual level, s/he knows damn well there’s a good enough justification for it. I can also say that professionally-coached CPR by 911 agencies is good enough to demand it if your area doesn’t have it yet.

I can also say honestly that I once “saved” a 98 year old man who had quietly stopped breathing, all unnoticed, during the service in his regular seat at church. Thanks to me and his co-worshippers, he died, not peacefully and surrounded by beloved family and friends in what he regarded as the house of his god, but several weeks later, naked and intubated and fitfully conscious under high-wattage fluorescent lights after several momentarily successful resuscitations. It was my first CPR instruction, but that’s not the reason I remember it best.

*Don’t be squeamish: pull Grand-dad off the bed by an arm and a leg onto the floor, with a huge thump, if necessary. I’ll bear the blame for hurting him: you get the credit for saving his life.

I’d have to agree with paperbackwriter’s comment:

I’m also an EMT, and I just re-certed in CPR. The most essential thing is that CPR is started as soon as possible, and I understand the reasoning that it be a stranger.
Panic is one thing, but I think most people are afraid of hurting their loved one, or are just plain afraid. Yeah, you have to drag them off the bed or sofa onto a hard surface, and you have to push pretty hard.

One woman who was in class with me sat cross-legged, pushing lightly on the dummy’s chest. I kept telling her had to be up on her knees with her arms and shoulders straight up and over the patient, and she had to push hard enough to make the clicky sound in the dummy’s chest. She claimed she’d rather be the person sent to call 911 than to actually do CPR.

I’ve personally never had to perform it on a patient (but I have bagged someone who had collapsed - someone else was doing the CPR), but I’ve been on plenty of cardiac arrest calls.

Hi, BiblioCat, and please accept my best regards and wishes.

No argument that the people who know and love the victim are often poorly emotionally equipped to hurt them in order to help them, but they are almost always (in my experience, and, I’ll bet, yours too) the ones best logistically situated to help them, being so often the only ones there and all. It takes (I’ll blow, if not my own horn, at least that of my betters) empathy and emotional control and sometimes enormous force of will) to get even friends or family to manhandle a patient in the necessary way to keep them viable (you won’t get me to say “alive”). For those watching, we should mention that in real life, we don’t get a choice.

Also, don’t underestimate the reluctance of people to do CPR on a stranger – I’d say that’s much harder to overcome, having talked to plenty of people in both situations, although I admit that most of the latter situations involve street persons whom callers would be reluctant to approach under any circumstances. Still, that’s the way it is in my neck of the woods. All in all, I’d rather have 50% of 911 callers willing to answer all questions and do what they’re told than have 100% take a basic CPR class once.

Your agency must operate differently than I can imagine – how can an EMT have been on plenty of CARDARs but not ever have performed CPR, even in relief? I understand the bagging, but even that’s normally secondary to circulation. I can suppose that you guys are extra-ordinarily fast after declaring CARDAR, and that your hospital transports are instant and short, but even so, what you’re telling me is admirable but outside anything I can apply to my own experience.

You are a 911 dispatcher, right? That’s what I’m getting from your post. Just to clarify for my own curiosity.

I ride at a volunteer station. We usually have four people riding - we sometimes have to kick people off, or it’s like Clown Car Ambulance. “Plenty” of cardiac calls was probably a bit of a misnomer. It’s more like “a lot,” if that’s better. We do get a ton of cardiac calls, though.
There are a couple of guys at my station who are into the whole ‘hero’ mentality, and they rush to be the one to start CPR while forgetting about O2.
If I want to be involved at all, bagging is the way to do it. (I know, I should be more assertive, but when it comes to vollie firehouse politics, this fight ain’t worth it.) Usually one of the guys will start CPR, and switch out with someone else, usually a paramedic who has also arrived. Once the paramedics get there, we lowly EMTs end up standing around. :wink:

With my department(s), it’s the other way around. Basics are most likely to be bagging and thumping, because the -Is and -Ps are too busy intubating and setting up IVs to administer the epi.

I feel this needs some explanation. Obviously if your middle school is directly struck by a 1 megaton bomb, sitting under your desk is useless as the school, desk, you and everything within several miles will be vaporized.

Where the “duck and cover” technique is effective is if you are several miles from ground zero and the immediate blast area. Assuming you are far enough away that the concrete building your are being taught in provides adequate protection against the immediate thermal and radiation effects of the bomb, you can expect to be hit by a shockwave a few seconds later. Again, assuming that you are far enough away from ground zero that the shock wave doesn’t obliterate the building (concrete is actually pretty resiliant), it will shatter windows and knock around anything that isn’t tied down. Ergo, your desk provides a bit more protection from flying glass, falling ceiling tiles, Jimmy’s lunch box, the stupid globe at the front of the room and so on.
It’s kind of like seatbelts on an airplane. You never hear of a plane crashing into a mountain and exploding and everyone lived because they all had their seatbelts on.

We’re a very small company, out beyond East Podunk. There’s only 2 EMT-I’s and no P’s. We’re supplemented by the county’s career medics.
Like I said, some of it is politics. I’m don’t need to get in a pissing match over who gets to do CPR. If the ‘heros’ want to jump out before we’ve even stopped and run in to start CPR, leaving me or someone else to get the bags and O2, so be it.

I don’t want this to turn into a pissing match. That said, I do think the comment about a big leaguer’s three at-bats is somewhat disrespectful. I said that not to establish myself as the be-all and end-all expert. Rather I said that so the question writer uderstood I had had cause to actually apply CPR training in real life. I am not an EMT any longer, and haven’t been for some years. I am, however, a researcher and writer specializing in medical topics, which I think qualifies me to present research that other parties have done.

Speaking of which research, the article by Casper et. al. contradicts your anecdotal experience about strangers versus loved ones. This study took place in Boston, and included all witnessed nontraumatic cardiac arrests in that city between 1994 and 1998, a total of 415 cases. Bystanders that knew the victim initiated CPR 15.5% of the time. Bystanders that did not know the victim initiated CPR 45.8% of the time.

Another study in Royal Oak, MI[sup]*[/sup] supports this conclusion. in 927 out-of-hospital witnessed cardiac arrest cases between 1989 and 1993, only 229 received CPR from a bystander. The only stastically significant predictor of who received CPR was those who had an arrest outside their home. That is, in the presence of strangers (although the researchers did not ask about the relationship between the CPR performer and the victim).

Regional differences between these locations and your service area may well mean that your conclusion is sound, I’m not disputing that. I just want to show that I did not make the assertion about strangers without some good evidence.

You are right, of course, about “pulling Grandpa off the bed.” I will say that’s not the worst part about CPR on the elderly, though. It’s breaking the ribs of the victim, which is almost a guarantee if you’re doing it strongly enough. You’re absolutely right about not being squemish if you want to do any good.

[sup]*[/sup]Jackson, R.E., R.A. Swor. “Who gets bystander cardiopulmonary resuscitation in a witnessed arrest?” Academic Emergency Medicine. 1997 Jun;4(6):540-4.

outlierrn said:

Stress is subjective. If I know nothing and know I know nothing, does it stress me out to not save the person’s life when there was nothing I could do? Versus thinking there’s something I can do and learn later it didn’t help? But yes, that does somewhat offset the downside. I was just being thorough. There is a downside. It might be mitigated or offset, but it is still there.
The King of Soup said:

There are different factors that contribute and/or demonstrate a person’s willingness to try CPR. Knowing the person seems like it should be a motivator to try CPR, because you care if the person lives, but apparently research bears out that it is a disincentive because you don’t want to hurt the person. However, someone who seeks out and takes a CPR on their own (and own expense) seems to be making a decision to put effort toward giving CPR vs an untrained person who never made that effort. That said, if the person on scene is untrained but willing, you’re better off than a marginally trained person who, under the gun, decides to be squeamish.

Yes, that is a very valid criticism of my posted downside. Someone has to bear the costs of maintaining classes and equipment for those general population CPR classes. Usually the class attendees pay a fee. Do those fees fully account for the class costs?

The King of Soup said:

That’s a “feature”. In order to embed quotes, you have to reapply the quote tag. This is three nested quotes, the first two citing the poster’s name in the quote tag.

Here is the link on using BBcode.

Again, that factors in to the motivations for CPR. It is harder to motivate you to risk yourself to disease or danger to touch some scuzzy person who smells bad than it is to take on CPR for a clean, averagely dressed suburbanite.
msmith537, I thought about posting something similar about duck and cover, but you did a much better job.

Apologies, of course, but no disrespect was involved. In my neck of the woods, three resuscitations correlates with not a whole lot of experience. Here, EMTs are almost always first on scene partly because we require even our firefighters to be EMTs and partly because they’re usually first to arrive (because there are lots more firestations spread thoughout our area than EMS stations) and therefore anyone who has been an EMT has usually been on scene at several cardiac arrests early in his/her career, and it is usually their lot to drop and begin compressions. And there are lots of CARDARs. In my admittedly limited experience, I’ve coached dozens of novices in CPR and in most of those cases CPR was continued after ALS unit(s) arrived. I’ve never been an EMT, but my research and reading (as a job requirement, same as your avocation) probably mirrors yours to some extent. I’m familiar, for example, with Casper, and (not to be confrontational) I’ll merely mention that when you restrict the category to “witnessed, nontraumatic cardiac arrest,” you’re pretty much eliminating every instance in which the victim is in public alone, or even at all, and any stranger even has an opportunity. There’s a huge difference between seeing someone’s uncle Ted, alive, moan and sink to the floor, and driving or walking or jogging by a body on the ground. The circumstances account for a lot of the bias in the study, I think. Of course the Royal Oak study only counts who did perform CPR, not the percentage of those who had opportunity, and suffers from the same bias.

A lot of it has to do with who you are and where you are. Badly dressed, the wrong color and in the wrong part of town, people might pull out their cell phones, but frequently that will be the extent of their efforts.

OK, this is my first post here, so be gentle. :smiley:

I have had similar discussions with a number of medical friends over the years. What is often missing from discussions about the merits of CPR, is the question of the underlying pathology. Why did the subject go into cardiac arrest in the first place? The assumption seems to almost always be that they have suffered a MCI. If you stop to think about it, any MCI is always going to have a very poor outlook. The heart has not simply stopped, it has suffered a serious injury. Keeping the subject alive (though ventilation and cardiac massage) does not alter the fact that the heart suffered sufficient an insult that it stopped in the first place. In all likelihood there is a big chunk of something clogging up an artery in the heart muscle, and a significant part of the heart is permanently dead. Prognosis here is really bad. Tissue plasminogen activator and other options may help a small number pull though, but it is always going to be bad.

However, there are a number of other reasons for the heart to stop. These do not involve damage. These include, other heart pathology - arrhythmia, other electrical issues (heart block), electrocution, poisons and venoms.

Heart fibrillation, sudden heart stoppage due to heart blocks. No actual damage. Get the heart going and there is every chance the subject will survive. Fit them with a pacemaker.

Electrocution. It would be very interesting to know how many emergency calls are related to electrocution. If you get the heart going, the subject is very likely to survive. Electrical burns can be very nasty indeed, and there is a point where enough power destroys so much tissue that there is no chance of survival, but simple household electrocution should have a very high survival rate if CPR is prompt.

Poisons and venoms. I live in Australia. We understand venomous creatures. Snakes, spiders, octopus, fish, jellyfish. Killers in all of them. Neurotoxins mostly. Subject stops breathing and soon after the heart stops. There are a number of recorded cases where a companion applied CPR, sometimes for hours, until help arrived. The subject was a wreck, bruised and battered sometimes with broken ribs, but after a day on life support, antivenin if needed, they made a full recovery.

That’s not really true. Most heart failure due to MCIs are a result of the formation of an ectopic pacemaker. In simple terms an area of heart tissue is damaged from the blockage and starts to initiate its own beat in conflict with the natural rhythm. That leads to heart failure. However the area of tissue death that produced the ectopic focus is usually tiny, just a few mm across. Moreover these damaged areas often heal themselves as vessel grow into them from above the blockage. That’s very different to the picture you paint where “a significant part of the heart is permanently dead”. These ectopic foci are usually neither significant or dead. In fact if they were dead they would be less life threatening. It’s the fact that they are alive that causes the problems.

Prognosis in these cases are usually pretty good if the patient can be kept alive until normal heart rhythm can be restored.

Hmmm, interesting. That brings it back to the question of why CPR has such a poor success rate. Is it that people give up too soon? Certainly in the CPR training I had, they emphasised that you didn’t give up.

There does seem to be a disparity in the statisics. How many people survive a MCI? What is the survival rate for CPR subjects? One would assume they should be close. But the implication is that they are not. Which suggests there is something we are not considering, or don’t know.