Fans of TV medical dramas know the drill. The patient in the emergency room becomes cardiac arrested and the resuscitation team takes action. The compressor begins to pump the patient’s chest, the airway manager begins to intubate, someone else prepares the defibrillator, screaming “transparent” and shocks the patient.
Building tension. The drug manager will administer epinephrine. The team leader shouts for direction. And because it’s Primetime TV, the family cries in the background.
Then, all of a sudden, they have a pulse. Heart activity is back. The patient is saved, and by the end of the episode, they are walking outside the door, thanking the medical team.
In real life, cardiopulmonary resuscitation (CPR) rarely works, but most people believe it is effective. Researchers have found that unsuccessful attempts can negatively affect healthcare providers and cause fatal distress.
Why are few people surviving CPR?
On television, CPR saves lives and it is being studied that most characters who have undergone CPR survive the ordeal. 2015 Survey in resuscitation We investigated 91 episodes of medical dramas house and Gray’s anatomy. Someone performed the CPR in half the episode, and about 70% of the characters survived the attempt to revive. Only 15% of those who survived died in the aftermath. The rest was discharged from the hospital.
Many people hope that CPR will be as effective and life-saving as you can see on television. In research by manufacturers who decide on surrogate ICU patients72% of respondents We thought the success rate of CPR was above 75%. In reality, people undergoing CPR outside of hospital environmentsSurvive just 10%Time. In a hospital setting, CPR survival rates are slightly higher, at around 17%. CPR often fails because most people are “or “flat lining” when there is a cardiac event. They have no electrical heart activity and cannot respond to electric shocks.
“Sadly, under 25% of patients exhibit shocking rhythms, and this number is declining,” says Patrick Druwe, a doctor and graduate researcher at Ghent University Hospital in Belgium.
The number of people with shockable rhythms has simultaneously become the standard procedure for CPR. In some countries, Like JapanEMT is legally prohibited from halting CPR in people who have undergone cardiac arrest outside of the hospital environment.
“When CPR was introduced into medicine in the ’60s, the intention was to treat obviously reversible causes of cardiac arrest, such as myocardial infarction,” says Druwe. “Currently, CPR has become a kind of ritual that is performed by default without considering the probability of a good outcome.”
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Handling CPR results
Bad outcomes are not just limited to death. Those who survived CPR suffer physical injuries. More 70% of people People undergoing CPR who experience a rib fracture with an average 7.6 rib bone breaking.
Survivors can also suffer from neurological problems as their brains are deprived of oxygen. Post-heart brain injury It is the main cause of death or disability after resuscitation.
Resuscitation survival rates remain “static” worldwide, Druwe says. But there it is It’s increasing Resuscitation events, especially in nursing homes. For example, in Denmark, the CPR rate for nursing homes was 3.5% in 2002. By 2014, CPR usage had quadrupled to 16.5%. Similarly, in Japan, nursing homes’ CPR rates have jumped to 12-20% over five years.
Performing CPR on patients in elderly care homes or patients with no shockable rhythms can be what some clinicians consider to be an “inappropriate attempt” because the patient is unlikely to withstand resuscitation.
Inappropriate attempts can be problematic for the patient and their healthcare team.
CPR can lead to moral distress
in 2021 Research in resuscitation, Druwé and his research partners sought to understand how clinicians felt about vain attempts to resuscate. They investigated approximately 5,100 emergency room doctors, nurses, and EMTs in 24 countries, including the United States, to determine whether the failed attempts caused moral distress. In this study, two-thirds of clinicians questioned whether the resuscitation event they participated was appropriate and 50% had experienced moral distress.
Part of this moral distress came from the fact that this attempt felt futile.
While many clinicians assume that patients want CPR, Druwé says few patients show that they want CPR regardless of the situation. And given that few nursing home residents survive CPR, futile attempts can make clinicians feel against what is best for their patients.
“In this way, CPR can be considered dehumanised because it violates the patient’s dignity and violates inappropriate ethical principles, and therefore has little chance of survival with neurological outcomes,” Druwe says.
Given that failure to CPR can cause both patients and providers, Druwé says that a more sophisticated directive should be focused on, as clinicians know how to proceed during cardiac events.
Druwé says that health organizations should also leave CPR as default and instead consider them as conditional treatments used when patients may survive and live without injuries after severe resuscitation.
“Experts must weigh the potential for future life if CPR fails, and how much the patient will be deprived of his dignified death if CPR fails,” he says.
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Emilie Lucchesi writes for some of the nation’s largest newspapers, including The New York Times, Chicago Tribune, and the Los Angeles Times. She holds a Bachelor of Arts in Journalism from the University of Missouri and an MA from DePaul University. She also holds a PhD. Within communications from the University of Illinois University of Chicago, I focus on media framing, message construction and stigma communication. Emily has written three non-fiction books. Surviving her third Light in the Dark: Ted Bundy, released on October 3, 2023 by the Chicago Review Press, co-authored with survivor Kathy Kleiner Rubin.
