[HN Gopher] CPR's true survival rate is lower than many people t...
___________________________________________________________________
CPR's true survival rate is lower than many people think
Author : rntn
Score : 173 points
Date : 2023-05-29 19:09 UTC (1 days ago)
(HTM) web link (www.npr.org)
(TXT) w3m dump (www.npr.org)
| Gordonjcp wrote:
| You can't make dead any deader.
|
| It might work. You may as well give it a shot, if only to say
| "well, at least I gave it a shot".
| sccxy wrote:
| Do your best to give their family $200k medical bill.
| lljk_kennedy wrote:
| Or not, if you're not American.
| Vaslo wrote:
| Or prioritize your funds to pay for your healthcare, like
| most responsible Americans do.
| JshWright wrote:
| You can be a very responsible person and still not be
| able to cover a sudden expense that is a significant
| fraction (if not a multiple) of you annual income.
| sccxy wrote:
| Two-thirds of people who file for bankruptcy cite medical
| issues as a key contributor to their financial downfall.
|
| What most people do not realize, according to one
| researcher, is that their health insurance may not be
| enough to protect them.
|
| https://www.cnbc.com/2019/02/11/this-is-the-real-reason-
| most...
| Gordonjcp wrote:
| Maybe don't live in a country with third-world
| healthcare, then.
| fsckboy wrote:
| healthcare still costs regardless of who pays for it.
|
| And the countries with the most comprehensive socialized
| systems also pride themselves on their civic-mindedness,
| think about others, not just yourself: shouldn't you, out
| of civic duty, balance trying to save the public money at
| the same time as you decide whether you save a life?
| Gordonjcp wrote:
| Why would they get a "medical bill"?
| hnthrowaway8860 wrote:
| [flagged]
| dghlsakjg wrote:
| Generally CPR is performed when there is no pulse or breathing as
| a last ditch effort to keep a brain viable until a full medical
| team can do their work.
|
| In other words CPR is performed on people who show no signs of
| life/are already dead.
|
| The survival rate for the control group is 0, so it is kind of a
| miracle that anyone survives.
| brianwawok wrote:
| It's not that simple. People who do not get CPR live. Others
| who get CPR didn't need it. Control group of 0 is missing the
| complexities of real life.
| dreamcompiler wrote:
| It is that simple. CPR -- if done properly -- is only done on
| dead people. Dead people don't come back on their own. And if
| CPR is done on somebody who "doesn't need it" then by
| definition it was done wrong, because they weren't dead in
| the first place.
| akvadrako wrote:
| It will be done wrong, so you have to take that into
| account.
| shkkmo wrote:
| This is wrong, CPR almost never brings people back.
|
| What CPR does is provide minimal bloodflow and oxygenation
| until electricity can be used to get the heart beating
| properly again. By doing this, you extend the window during
| which an AED (or other defibrilator) can be used
| successfully and hopefully reduce brain damage in the event
| of that success.
|
| Indeed, if you have an AED, delaying its use to provide CPR
| is bad.
| groestl wrote:
| I was actually surprised to learn that survivors are in the upper
| single digits. After all, when you start CPR, people are already
| dead. Personally, I had to do CPR twice (as a paramedic), and
| sadly neither of the patients survived.
| Faaak wrote:
| Maybe dumb question here, but does it at least help to salvage
| the organs later on (if the donor was okay with it) ?
| uberuberuber wrote:
| Critical care medic here. Adult CPR at least has some evidence in
| its favor on a population level, but only as a bridge to using
| electricity. CPR alone is merely slowing deaths arrival.
|
| There is NO evidence to support any of the commonly used advanced
| cardiac life support drugs in terms of functioning brain leaving
| the hospital. Epinephrine (for arrest, not shock or anaphylaxis),
| atropine, lidocaine, amiodarone, procainamide, digitalis, etc.
| Its electricity or bust.
|
| Just one of many reviews on this:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129833/
| JumpCrisscross wrote:
| Would it make sense for households with those at risk of heart
| attack to invest in an AED?
| rdmirza wrote:
| Even better is installing an implantable cardiac
| defibrillator (ICD) in those at high risk.
| noughtme wrote:
| > at high risk.
|
| Before an event? I'm not sure what insurance would cover
| this. I don't really want open heart surgery before I need
| it.
| Calavar wrote:
| Plenty of insurance plans cover ICD implantation because
| it is recommended by the American College of Cardiology
| for specific situations:
|
| 1. moderately to severely reduced systolic function of
| the heart due to a heart attack that persists > 40 days
| after the heart attack
|
| 2. severely reduced systolic function of the heart of any
| cause that does not improve after 3 to 6 months of
| pharmacologic therapy
|
| 3. personal history of sudden cardiac death with a
| persistent risk factor
|
| ICD implantation is not open heart surgery. It is a
| relatively quick procedure that is done by a cardiologist
| rather than a cardiothoracic surgeon.
| plugin-baby wrote:
| > personal history of sudden cardiac death with a
| persistent risk factor
|
| Personal history, or family history? Maybe this is a
| technical term? As a non-medic I can't imagine there are
| many people who have a history of sudden death AND a
| persistent risk of it happening again.
| Calavar wrote:
| Personal history.
|
| "Many" is relative. We are talking about a fraction of a
| percent of the general population, but if you are looking
| specifically at the population of people who have some
| form of long standing heart disease, it's not terribly
| rare. I don't work in cardiology specifically, and even
| so I encounter one or two patients a year who have had an
| ICD placed for reason #3.
|
| Persistent risk factors include things like or overgrowth
| of muscular heart tissue (which has dozens of causes, but
| the most common is severe, long standing coronary artery
| disease) or scarring of the heart after a heart attack.
|
| Persistent risk factors are not rare at all. The thing is
| that most people who fall into bucket 3 also fall into
| buckets 1 or 2. So in an ideal world they would have
| already seen a cardiologist and had an ICD placed before
| they ever had an episode of SCD. And of course many of
| those who do have SCD don't survive long enough to have
| an ICD placed.
|
| If you are interested in reading more, you can search for
| "secondary prevention of sudden cardiac death" or
| "secondary prophylaxis of sudden cardisc death." There
| are some good review articles available online.
| gerdesj wrote:
| I would say yes. Some of the answers here are referring to
| population stats and you are worrying about your particular
| circumstances, which is different.
|
| If someone you come across (family, stranger, whatever) keels
| over you need to, without proper medical knowledge, diagnose
| the issue and then administer appropriate treatment. Oh and
| could you do it within a couple of minutes please.
|
| CPR should be a last resort - it can be rather barbaric. A
| defib has a way better chance of success and won't break your
| ribs.
|
| A defib costs around PS1000 or so. Hopefully that money is
| wasted.
| dreamcompiler wrote:
| More important: Call 911 and start CPR. 911 will always bring
| a defibrillator.
| jdietrich wrote:
| Generally not, for two reasons.
|
| Firstly, the people most at risk of cardiac arrest are
| unlikely to regain any meaningful quality of life after
| resuscitation. An AED might bring a very elderly and/or very
| ill person back from the dead, but more often than not
| they'll be _just barely_ alive afterwards, which is not an
| outcome that most people would choose for themselves. People
| who are close to the end of their natural lives would benefit
| much more from serious conversations about end-of-life care
| than expensive gadgets and false hope.
|
| Secondly, most of the risk of cardiac arrest in younger and
| relatively healthier people is preventable. If you're not a
| frail elderly person but you consider yourself at risk of
| cardiac arrest, it's very likely that you're at least one of:
| obese, sedentary, hypertensive, poorly-managed diabetic.
| Before you go out and buy an AED, give some serious thought
| to what kind of state you'd be in after surviving a cardiac
| arrest and to whether you'd rather take meaningful action to
| improve your health now.
|
| Some people with cardiac abnormalities might be good
| candidates for an at-home AED, but they'd generally be better
| candidates for an ICD. A young and otherwise healthy person
| with a condition like LQTS, Brugada or severe HCM is at very
| real risk of sudden cardiac arrest, but the most likely
| trigger for that arrest would be strenuous physical exercise
| - something that most of us don't do in our own homes.
| robbiep wrote:
| The most common cause of sudden cardiac death is blocked left
| anterior descending artery.
|
| Generally this is unknown until it happens.
|
| It kills 250,000 Americans every year.
|
| It would make the most sense for people above 50 with a
| family history of heart disease to have a CT coronary
| angiogram or for those above 40 to have a Cardiac Calcium
| Score to risk stratify for future CTCA.
|
| Distributing AEDs is infrastructure heavy and indiscriminate
| because you don't know who actually needs one.
| tomatocracy wrote:
| In the UK, in addition to what the sibling comment
| mentioned about phone boxes, a lot of workplaces now have
| AEDs on site (eg I know mine does) and they're also common
| at large-scale events. I don't know if there are any
| statistics on how much good they've done but that seems
| like quite a sensible approach to me as you can presumably
| get quite a lot of population coverage quite cheaply.
|
| By contrast, a CT coronary angiogram I suspect is rather
| more resource heavy - in particular I suspect having enough
| qualified cardiologists to interpret the results (not just
| having CT machines and staff to administer the test) might
| be a bottleneck (anecdotal, but having had one myself due
| to family history of heart disease, I had a longer wait for
| results after the scan than to get the scan itself).
| robbiep wrote:
| It's risk stratification vs preventative care. You don't
| WANT someone to have a heart attack and require the AED,
| because you've only got a 5-20% chance of making it out
| of hospital.
|
| These things are not equivalant!!!
|
| Risk stratification for AEDs at work and public events,
| whereas screening should increasingly be part of the plan
| particularly if you have a family history (defined as 1
| or more relatives who died younger than 65 from a heart
| attack)
|
| CTCA doesn't require a cardiologist, just a radiologist,
| but a cardiologist referral makes it free (in australia)
| otherwise it's $500. Which is pretty good really
| sacnoradhq wrote:
| There's a cardiologist dark joke about this.
|
| We should be sending ~10 million more patients to the cath
| lab prophylactically to get a baseline.
| moffkalast wrote:
| Well as long as it only kills Americans, then the simple
| solution is to emigrate /s
| gerdesj wrote:
| Quite a lot of people/families can find PS500-1000 for
| something important. The more that can, the cheaper it will
| become.
|
| AEDs/Defibs are just an expensive battery powered thing,
| that we just don't bother to discuss. With around an hour
| or less training, you can expect to be at least 10x more
| effective than the best CPR. CPR is horrible to deploy and
| very complicated but I will if I have no choice.
| robbiep wrote:
| They're not equivalent though! An AED means your heart
| muscle has been absolutely trashed and will never be the
| same again. Plus, there's still the issue of who actually
| needs an AED in their house, and if you know that,
| they've probably got an IED.
|
| Whereas if you can for the same cost have a scan after
| being reviewed appropriately, you can avoid the heart
| muscle trashing. That is nothing short of a miracle in
| terms of the extension of lifespan available
| stbede wrote:
| They are about $500 on the cheap end if I'm not mistaken.
| ericd wrote:
| At $1k, it's not a no-brainer, but it's also not that
| expensive in the context of the risk it counters.
| w10-1 wrote:
| "only as a bridge to using electricity"
|
| The key point is that the AED (automatic electric
| defibrillator) will tell you if you have a shockable rhythm.
|
| Many modern AED's can be used by untrained people, so if you
| see a cardiac arrest, find the nearest AED and deliver it
| and/or follow its (brief) instructions. Once you know this,
| you'll start tracking the last one you saw, and you'll find
| them more ubiquitous than you realized (and start advocating
| for one in your office).
|
| (And if you are doing CPR, the breathing part is less important
| than the chest compressions. Blood flow is more important than
| oxygenation. But always/only follow current
| guidelines/training.)
| bsder wrote:
| > (And if you are doing CPR, the breathing part is less
| important than the chest compressions. Blood flow is more
| important than oxygenation. But always/only follow current
| guidelines/training.)
|
| The problem is that this advice is situational.
|
| If electrocution is what caused the cardiac arrest, it is
| much better to give breaths than compressions. The heartbeat
| system resets itself before the respiratory system. The
| problem is then that the heart is back, uses up all its
| energy reserves, but there is no oxygen to replenish and the
| heart goes back into arrest.
| 7a1c9427 wrote:
| > If electrocution is what caused the cardiac arrest, it is
| much better to give breaths than compressions. The
| heartbeat system resets itself before the respiratory
| system. The problem is then that the heart is back, uses up
| all its energy reserves, but there is no oxygen to
| replenish and the heart goes back into arrest.
|
| Can you provide a reference or citation to this claim and
| practice?
|
| It is always much better to give "conventional CPR"
| (breaths and chest compressions) if suitably trained.[1] If
| not suitably trained you are more likely to a) perform CPR
| and b) do it effectively if not providing mouth to mouth
| breathing.[2][3] You can argue about the nuance of
| particular patient groups where there is potentially a
| statistically significant benefit of providing conventional
| CPR over compression only.
|
| Under no circumstances are there benefits to providing
| rescue breaths without chest compressions (as your comment
| seems to recommend).
|
| [1]: https://pubmed.ncbi.nlm.nih.gov/21273279/ [2]:
| https://pubmed.ncbi.nlm.nih.gov/7726702/ [3]:
| https://pubmed.ncbi.nlm.nih.gov/17420082/
| bsder wrote:
| I think it was a while ago down a rabbit hole from the
| "Kiss of Life" picture talking about respiratory arrest.
| However, I can't find a substantiated source anymore so I
| will absolutely defer to your sources.
| elevaet wrote:
| What's the fastest way to find the nearest AED?
| kej wrote:
| There's an app for that:
| https://www.pulsepoint.org/download
| 7a1c9427 wrote:
| Depending on your country the GoodSAM app potentially has
| good mapping/coverage of AED locations:
| https://www.goodsamapp.org/aed
| stbede wrote:
| At least where I live, it's a requirement in order to
| operate a business. If you go anywhere and ask for their
| AED and they don't have one they can be shut down.
| truculent wrote:
| In the UK, many old phone boxes have been converted to
| house defibrillators:
|
| [0]: https://www.independent.co.uk/news/uk/home-news/red-
| phone-bo...
|
| [1]: https://www.communityheartbeat.org.uk/convert-phone-
| box
| jdietrich wrote:
| In most countries, by asking the emergency dispatcher when
| you call for an ambulance. Start chest compressions, get
| someone to call for an ambulance, _then_ worry about
| finding an AED.
| FireBeyond wrote:
| > Many modern AED's can be used by untrained people, so if
| you see a cardiac arrest, find the nearest AED and deliver it
| and/or follow its (brief) instructions.
|
| AEDs are specifically designed to be used by untrained
| people.
|
| Don't bother doing anything with ventilation unless it's a
| pediatric patient who arrested specifically because of an
| airway issue (foreign body, near-drowning). We (EMS) will
| ventilate with high flow oxygen and intubate on our arrival,
| but even for us, it still comes a distant second to
| compressions and electricity.
|
| With adults, blood can remain sufficiently oxygenated for
| cellular respiration/metabolism for about 8 minutes of
| compressions. Survival rates for adult CPR as a rough average
| go down about 10% for every minute of compressions required.
| brianwawok wrote:
| As far as I can tell, many modern CPR classes dropped the
| breath part. Just focus on the chest part.
| thaumaturgy wrote:
| Sort of. CPR classes are divided into, at least, "CPR" and
| "BLS". Your basic CPR class may be a hands-only training,
| but the BLS classes still include rescue breathing and AED
| use, along with infant care.
| grogenaut wrote:
| Took a BLS course in the last year in the US (PNW)...
| they barely covered breathing. I'm not actually sure,
| from taking it, when I would do breathing. They did a lot
| on the AED. I should re-watch the video.
| lazyasciiart wrote:
| I just did my cert in the PNW this month - there was
| plenty of time spent on breathing, but also emphasis that
| doing compressions is the important part. Interestingly,
| the instructor thought this change was mostly due to
| amateurs being far less comfortable with giving breaths
| and being likely to refrain from CPR altogether if they
| thought it was necessary to do the breathing.
|
| FWIW I have done it by video during covid and in a live
| class before and after, and I did find it much more
| engaging and memorable in person. It was surprising to
| realize that, but simply having the additional sense
| memories seems to have made a big difference to retaining
| the information.
| thaumaturgy wrote:
| Ah. I have a current AHA BLS cert. My understanding is,
| do breathing if you think there is a clear airway, and
| you have the appropriate PPE depending on the fluids
| on/around the person's mouth, and either you are doing
| compressions because there is no pulse _or_ there is a
| pulse but the person is not breathing on their own. If
| you do choose to do rescue breathing, it 's important to
| watch for chest rise to ensure that you're not breathing
| into their stomach, which is ineffective and will induce
| vomiting if the person regains consciousness.
|
| There is a decision tree there that some people may be
| uncomfortable with in an emergency.
|
| I welcome corrections from people with better training
| than mine.
| FireBeyond wrote:
| Same here. And yup. Early effective compressions and early
| access to defibrillation.
| dreamcompiler wrote:
| EMT here. I've had exactly one save in my career from CPR
| without external defibrillation. That save happened only
| because of epi, and the patient was disconnected the next day
| because of brain death.
|
| So yeah, CPR is great but if you don't also have an AED, it's
| just theater.
|
| Caveat: If you call 911 [in the USA] they will bring an AED! So
| don't let the fact that you don't own an AED stop you from
| starting CPR. Just be sure somebody calls 911 also.
| Daub wrote:
| Glad you said this. I have delivered cpr twice: once to my
| lecturer at school, the other to a stranger in the street.
| Both times they died. The experience of seeing people freak
| out when they saw their loved one dying completely devastated
| me out. Still now the memories are painful.
|
| I told my father, who worked in medicine. He recommended that
| unless there was a defibrillator nearby, I walk away next
| time I see someone having a heart attack.
| JshWright wrote:
| Just to be clear, a "heart attack" commonly refers to a
| myocardial infarction (part of the hear tis being deprived
| of blood, generally due to an obstruction in a coronary
| artery). Someone in the early stages of a heart attack will
| generally (but not always) experience chest pain/etc,
| anxiety, shortness of breath, etc.
|
| A heart attack can lead to cardiac arrest, where the heart
| stops beating effectively and the patient loses
| consciousness. Cardiac arrest is the scenario you're
| talking about (where CPR is indicated)
| sacnoradhq wrote:
| TLDR:
|
| 1. AEDs should be everywhere.
|
| 2. CPR isn't perfect but it works sometimes.
|
| -----
|
| 1. Get an AED if you can and keep it near your home and/or
| vehicle.
|
| 2. Just don't expect complete recovery miracle revivals like
| the movies.
| LorenPechtel wrote:
| If it's just theater without an AED then why was it done
| before the AED came about?
| snowwrestler wrote:
| > So yeah, CPR is great but if you don't also have an AED,
| it's just theater.
|
| There's at least one scenario where this is less true:
| drowning. An otherwise healthy person, pulled promptly from
| the water but not breathing, has a chance of being revived
| with CPR.
|
| There are a lot of drowning situations where an AED or EMT
| are far away, and CPR should definitely be attempted.
| dathinab wrote:
| worse CPR doesn't do what people think it does
|
| CPR is not a live saving measure, it's a temporary live extension
| if it's not followed up with other measurements it's likely to
| not save a live. And that's assuming it does work, and is done
| correctly.
|
| but anyway it gives people another chance at live they most
| likely wouldn't have had otherwise
| [deleted]
| YetAnotherNick wrote:
| > The traumatic nature of CPR may be why as many as half of
| patients who survive wish they hadn't received it, even though
| they lived.
|
| It's the peak of coming up with data to make a story. The study
| was only for old people with chronic disease, where lot of them
| wouldn't want any life saving treatment let alone CPR. And even
| in that group if >50% of said they were happy to have gotten CPR.
| imglorp wrote:
| A common expression is, if they need CPR, they're _dead_ at
| that point and you can only improve their chances of reaching
| definitive care, even if it's long odds. And yes there will
| probably be side effects to complain about. If the patient
| decided they didn't want that, ahead of time, they could have a
| DNR in place.
| hirundo wrote:
| "The 2000 Federal Cardiac Arrest Survival Act grants those who
| administer CPR or use an AED immunity from civil charges, except
| in instances of willful misconduct or gross negligence."
|
| That should make it less risky to try and help in the U.S. But
| apparently it can still be a choice that's easy to get wrong.
| That makes me less likely to jump in as a bystander, and to bias
| intervention toward healthier looking victims who look like they
| could tolerate the treatment.
|
| https://www.cprcertified.com/blog/can-you-be-sued-for-perfor...
| [deleted]
| dghlsakjg wrote:
| On the other hand: More payouts are made for people NOT
| providing lifesaving care when they should.
|
| https://newsroom.heart.org/news/legal-risk-of-not-performing...
| querez wrote:
| Not sure what the situation is in the US, but I've taken 3-4
| first aid courses in my life (it's compulsory to get a driver's
| license where I live). Every time, they told us that CPR survival
| rates were abysmal if we aren't also using an AED. IIRC, with an
| AED the survival rate goes up significantly -- though this
| article states that in-hospital survival rates are only at 17%,
| which indicates it's not all that great with AED, either.
| willmadden wrote:
| Yeah, sure NPR. I'll take the CPR thank you very much. Next.
| dang wrote:
| Could you please review the site guidelines and stick to them?
| Your comment here broke quite a few of them, including:
|
| " _Please respond to the strongest plausible interpretation of
| what someone says, not a weaker one that 's easier to
| criticize._"
|
| " _Please don 't post shallow dismissals, especially of other
| people's work. A good critical comment teaches us something._"
|
| " _Don 't be snarky. [...] Edit out swipes._"
|
| https://news.ycombinator.com/newsguidelines.html
| willmadden wrote:
| I didn't break the rules you cited. There is literally no
| comment to which I could respond. The OP linked a terrible
| article from a state sponsored news source.
|
| If I'm dying, I'll take the CPR. It's better than the
| alternative.
|
| If you want a longer response, this article is state
| sponsored propaganda that promotes non-resuscitation. I find
| this article deeply offensive and disturbing, both morally
| and spiritually. It's a great illustration of how the values
| of western governments have diverged from those of their
| people.
| giraffe_lady wrote:
| 100% agree. Thank you.
| JshWright wrote:
| > If I'm dying, I'll take the CPR. It's better than the
| alternative.
|
| No, it isn't... There are many outcomes of resuscitation
| that are not at all better than simply passing peacefully
| where you were. A lot of resuscitations end up with someone
| in the hospital, in a coma, for a few days before finally
| dying (with an expensive medical bill for their estate).
| Even worse, folks can often end up with a severe brain
| injury, but survive for many years with a very poor quality
| of life.
|
| It is totally fine that you would prefer CPR to be
| performed at your current stage in life. That is the
| default state, and what will happen if you experience a
| sudden cardiac arrest. For many people, they would likely
| make a different decision, given all the information. This
| piece is intended to help give people some of that
| information so that they can then have a more informed
| conversation with their doctor about end of life care,
| DNRs, etc.
|
| I'm also curious why you're hung up on the "state
| sponsored" bit. NPR does receive a very small amount of
| federal funding (certainly much less than, e.g. Tesla or
| SpaceX have received), but that funding does not impart any
| editorial oversight (nor is there any mechanism for that
| oversight to take place). This particular post is clearly
| labelled as a "Perspective" (i.e. an opinion), written by
| an emergency physician.
|
| The notion of CPR in general (prolonging life at all costs)
| is a very "western" approach to medicine, so if promoting
| "the values of western governments" was the point of this
| post, it did a very poor job of it.
| JohnMakin wrote:
| This isn't a secret. I was required to be CPR Certified for a
| decade. Every class I ever took, the instructor made it clear
| that it only makes a small difference in survival outcomes, in
| order to teach students that "you shouldn't be scared to do it."
| If done properly you should break ribs. They also teach this in
| classes. I don't think anyone is under the illusion that CPR is a
| hugely high-percentage life saving technique, except maybe the
| public at large, but the public at large believes a lot of
| stupid, untrue things.
| strunz wrote:
| This is covered in the article:
|
| >In real life, people similarly believe that survival after CPR
| is over 75%.
|
| Also:
|
| >I don't think anyone is under the illusion that CPR is a
| hugely high-percentage life saving technique, except maybe the
| public at large
|
| You don't think anyone believes this, except almost everyone?
| JohnMakin wrote:
| It's unclear what exactly the article is trying to conclude,
| but it seems to imply there's some agenda to keep doing this
| technique despite evidence to the contrary - perhaps I should
| clarify by saying "no medical professional is under the
| illusion." They know the odds, and have for decades, and it
| is still recommended training for people, and it should be.
| themantalope wrote:
| Weird way to say that people should talk to their doctors about
| how they want to die before the time is upon them.
|
| Major problem in the US. See it every day at my job.
| piloto_ciego wrote:
| The one time I administered CPR both victims of the accident I
| stopped at died. In retrospect they were already goners (both
| ejected from the car) and I didn't know what I was doing - hell
| none of us really did, but we tried.
|
| It was objectively one of the most traumatic experiences of my
| life and I used to dream about those people's faces for a long
| time - indeed I can still see them if I try. Regardless, we tried
| and I wouldn't have it any other way. We tried.
|
| I wrote a poem about it a few years ago:
|
| Violence
|
| Do you people know what it looks like when a man dies?
|
| What you think his fucking soul flies?
|
| As he serenely and comfortably lies,
|
| And he flutters his contented eyes?
|
| Not at all - there's blood and pain, And vomit in his mouth, and
| foul brutal smells of bile and shit, and his eyes look crazy and
| wild, as you pound on his chest to exhaustion, "Scoop out the
| mouth - take those kids out of here, somebody fucking call 911!"
|
| <ah ah ah ah stayin' alive stayin' alive> <ah ah ah ah stayin'
| alive stayin' alive>
|
| They don't tell you CPR never works, Or how the body jerks, Then
| the EMT smirks, "I can't zap him again, but dudes dead."
|
| So it was done, and I drove my truck to the truck stop to buy gas
| and clean the blood from my hands and jacket and reconcile with
| the two ghosts that had crawled into my head.
| zackkatz wrote:
| This article doesn't really address statistics for younger
| people. I feel like the headline should be: should elderly people
| be given CPR? For me the answer is a strong no. Why on Earth
| would you give CPR to a 90-year old person!?
|
| > survival after out-of-hospital CPR dropped from 6.7% for
| patients in their 70s to just 2.4% for those over 90
| DoreenMichele wrote:
| The title was changed and not necessarily for the better. This is
| a piece about the right to die with dignity, the right for
| elderly people to say "Yeah, I'm ready to let go. Heroic measures
| to keep me technically alive make no sense at this point."
|
| In some cases, you aren't _prolonging their life._ You 're
| dragging out their death and torturing them to do so.
|
| https://news.ycombinator.com/item?id=19598562
|
| I am also reminded of the scene in Aliens 3 where the android
| asks Ripley to simply shut him down because he's lost so much
| functionality that keeping him "alive" has no appeal for him.
| e40 wrote:
| Yep, my mom (84) had an older friend years ago. Had a medical
| directive that said "do not resuscitate" and her daughter
| ignored it. She spent a year in hospice before she died totally
| angry at her daughter for not following directions. Her quality
| of life was terrible. My mom has talked about this many times
| and sternly told me not even think about ignoring her
| directive.
| Arrath wrote:
| I'll always remember my Great Uncle, who begged my Grandfather
| every time he saw him, to bring him a pistol so he could end it
| and escape the torture that was his chemo treatments.
|
| There is absolutely a point past which all quality of life is
| destroyed and it isn't worth continuing care.
| bluefirebrand wrote:
| It's really unfortunate that we're socially very willing to
| let people suffer if that's the status quo, but helping
| someone end their suffering is considered horrible and is in
| many cases criminal.
|
| Just look at the recent online discussions around the MAID
| program in Canada. It's meant to be a compassionate end of
| life for people who have lost all hope, and people are
| twisting it to mean that Canada is just going to start
| euthanizing people instead of providing healthcare.
| DoreenMichele wrote:
| Yeah.
|
| Homelessness: "Personal issue." "Not our problem." "It's
| you're fault for being junkies and crazies and has
| _nothing_ to do with the general lack of affordable
| housing. "
|
| Incurable torturous medical stuff and want it over with:
| "No mercy for you. Heroic measures every step of the way
| until the bitter end."
|
| It's sadistic.
| jgeada wrote:
| But there is so much money to be made on the heroic measures
| front!
|
| Estimates range from 12% to 25% of lifetime healthcare expenses
| are accrued on the last year of life [eg
| https://www.cms.gov/Research-Statistics-Data-and-
| Systems/Res...]
|
| For profit healthcare is an obscenity.
| boringg wrote:
| What's the point of this article? Are we trying to get rid of CPR
| now so that people don't bother doing it because it has a low
| success rate? It is literally a last desperate effort to save
| someone in a really bad situation.
|
| I don't think anyone is under the allusion that CPR has like a
| 95% success rate do they?
| MengerSponge wrote:
| Doing CPR is scary and hard, and if it's okay to teach people
| that while it probably won't work, it won't make things worse,
| and if you're lucky it'll save a life.
|
| Transparency is a small kindness to help the people who do CPR
| not beat themselves up when it (probably) fails.
|
| *illusion (sorry)
| groestl wrote:
| I think the risk that people don't even start if they worry
| about survival rates is higher.
| henry2023 wrote:
| > it won't make things worse
|
| Maybe you should read the article.
| dghlsakjg wrote:
| One of the preconditions for CPR treatment is that the
| patient has no heartbeat. The patient is dead, or going to
| be dead (depending on how you define dead) very shortly
| without CPR.
|
| So, while the side effects of CPR can be pretty bad, not
| receiving CPR means guaranteed death.
|
| That's what people mean when they say it won't make things
| worse.
| rjmorris wrote:
| The article pointed to a study noting that about half of
| patients who survived wished they hadn't. In other words,
| they found survival to be a worse outcome than death.
| dghlsakjg wrote:
| What did the dead people report as their most desirable
| outcome?
| boringg wrote:
| What a strange quote and data point. So 1/4 people didn't
| want to survive, 1/2 didn't get a chance to choose and
| 1/4 was happy to survive.
| [deleted]
| grogenaut wrote:
| unless we're actively killing more people by doing cpr by
| accident than would have lived it's a net positive even if it's
| 1%.
|
| If you had a 1% chance to save your kid by oddly palpitating
| their chest... I'm betting you'd do it.
|
| Tho as we all know you have to say "live damn you live" and cry
| a bunch for it to work.
| aeternum wrote:
| Sure but what if you have a 2% chance of saving them by a
| thump to the heart, or a 20% chance by running to the
| store/business a couple blocks away and grabbing their AED.
| grogenaut wrote:
| During that time, a few blocks, they're likely been out for
| now 2+ minutes or more.
|
| Or you could you know, yell and get other people to call
| 911 and find an AED.
| oatmeal1 wrote:
| I would recommend reading the article.
| strunz wrote:
| Seriously, it's crazy how many people on here clearly didn't
| read it. I feel like I'm on Reddit. It says specifically:
|
| >In real life, people similarly believe [1] that survival
| after CPR is over 75%.
|
| [1] https://pubmed.ncbi.nlm.nih.gov/25711518/
| matkoniecz wrote:
| Make people aware that performing CPR on terminally ill people
| is not self-evidently a good idea. See "A 'natural death' may
| be preferable for many than enduring CPR" which is a title.
|
| > She has written about performing chest compressions on a
| frail, elderly patient and feeling his ribs crack like twigs.
| She found herself wishing she were "holding his hand in his
| last dying moments, instead of crushing his sternum." She told
| me that she's had nightmares about it. She described noticing
| his eyes, which were open, while she was performing CPR. Blood
| spurted out of his endotracheal tube with each compression.
|
| > "I felt like I was doing harm to him," she told me. "I felt
| like he deserved a more dignified death."
| boringg wrote:
| Agree completely - in that instance the individual should
| have some kind of DNR bracelet. That burden falls on the
| communication of the individual to wear something indicating
| DNR or requires an assessment at the time by the first
| responder to decide it isn't worth trying to save the
| individual and provide comfort instead.
|
| I think that assessment by a first responder is a very
| difficult decision to put on someone.
| jdietrich wrote:
| >Agree completely - in that instance the individual should
| have some kind of DNR bracelet.
|
| Even if you wear a DNR bracelet, there's a good chance that
| it'll be ignored. Bystanders often don't know to look for
| them and have no legal obligation to abide by them.
| Healthcare professionals routinely err on the side of
| caution if there is any doubt about the validity of a DNR
| order, in no small part because wrongful prolongation of
| life lawsuits are generally much less costly than wrongful
| death lawsuits.
|
| Advance healthcare planning is a much more complicated
| business than simply wearing a bracelet. We need a broad
| societal conversation about end-of-life care, not least
| because DNRs are often misunderstood by both patients and
| healthcare professionals.
| boringg wrote:
| I'm offering a simple first step to a complex situation.
| I don't think the default option is let's not help older
| people and resort to comfort.
| Spivak wrote:
| A fun new one I experienced recently when having a minor
| surgery was having to sign paperwork saying I consented
| to the doctor ignoring any DNRs, when I asked about it
| they said it was because if something happened to me
| while I was in their care it would make their numbers
| look bad.
|
| And oh man that's a no win if I've ever seen one.
| yarg wrote:
| Survival rates aside, CPR on the elderly can be particularly
| brutal.
|
| CPR is basically beating the crap out of someone in order to
| drag them back from death.
|
| You're talking about inflicting serious damage on people who
| take damage more easily, struggle to recover and are
| significantly more likely to suffer medical complications from
| even minor injuries.
|
| We like to place human life in an echelon of the sacred above
| all other life - and sometimes this leads to us being kinder to
| our pets than we are to ourselves.
|
| A healthcare system that prioritises quality over quantity of
| life could yield better results, but that's not going to happen
| as long as things are controlled by a gluttonous hydra of an
| industry that has a fiduciary duty to its stockholders, but no
| real duty of care to the patients.
| nordsieck wrote:
| > I don't think anyone is under the allusion that CPR has like
| a 95% success rate do they?
|
| When I was first taught CPR in school, it was taught without
| any reference to the survival statistics. The impression I got
| was that it was very effective.
|
| I don't know about 95% success rate, but I'd bet a lot of
| people think it has at least a 70% success rate.
| querez wrote:
| When I was thought it, it was clearly pointed out to me that
| chance of survival is ~5%, but increases significantly if an
| AED can be used in time. I've also been told about the rib
| cracking etc. Just as a counterpoint.
| basisword wrote:
| What use is this information though to someone performing
| CPR? It's important in the sense that maybe better techniques
| can be developed but if I need CPR it doesn't matter one bit
| if the person doing it knows it's success rate. In fact
| probably better they don't know. If they know the odds are
| low perhaps they'll give up too soon.
| WJW wrote:
| I could see an argument that knowing the statistics could
| help the CPR-giver in the aftermath. After all the patient
| is _very_ likely to die and if the CPR-giver was under the
| impression that it is likely to work, then they may feel a
| lot of unwarranted guilt.
| Sohcahtoa82 wrote:
| To absolve themselves of guilt and self-doubt.
|
| Someone who doesn't know that CPR has a very low success
| rate might perform CPR on someone that ends up not
| surviving and feeling guilty and full of self-doubt,
| thinking they performed CPR incorrectly.
| lazyasciiart wrote:
| There was a Reddit thread from someone who had spent
| years feeling that exact guilt for not saving her grandma
| https://www.reddit.com/r/BestofRedditorUpdates/comments/1
| 02k...
| dragonwriter wrote:
| > What use is this information though to someone performing
| CPR?
|
| Possibly quite important to their psychological condition
| afterwards, given what the very low effectiveness means.
| throwaway173738 wrote:
| I was taught it was not terribly effective except in case of
| lightning strike. We weren't taught how to do it in
| Mountaineering-Oriented First Aid because of that, and
| because the leadership, wound care, trauma, and specific
| conditions aspects of the course took almost the whole three
| days.
| duskwuff wrote:
| CPR is particularly unlikely to be life-saving in a
| wilderness scenario (like mountaineering) because
| professional medical care may be many hours away. Even if
| you can get a patient's heart restarted with CPR, they may
| not survive to reach a hospital.
| yarg wrote:
| I know a dude who's a very competent ambo, he saw a man
| collapse and immediately rebooted his heart with a single
| perfect strike to the chest.
|
| Beyond the prior state of the patient, technique can actually
| matter as well - but the fact is that the vast majority of
| people are never going to develop skills beyond "ah ah ah ah
| staying alive".
| BloominOnion wrote:
| Sounds like he administered a precordial thump.
| asperous wrote:
| The article links a source and says "In real life, people
| similarly believe that survival after CPR is over 75%"
| bscphil wrote:
| The real problem with the article is that it's conflating two
| things: the absolute rate of survival for cardiac arrest
| after CPR, and the relative rate of survival for cardiac
| arrest after CPR (versus doing nothing).
|
| > In real life, people similarly believe that survival after
| CPR is over 75%.
|
| I'm just a medically ignorant rando, my naive guess was that
| people survive cardiac arrest without intervention 30% of the
| time (per the article, the actual rate is 7.6%). Unless you
| measure people's beliefs about this, you won't be able to
| determine whether 75% is a good rate or a bad one.
|
| Apparently bystander initiated CPR, out of the hospital,
| increases those odds to 10%. That means that a _third_ more
| people will survive if bystanders initiate CPR. That seems
| ... really good to me? In the hospital, survival after CPR
| goes up to 17%, which is an increase of 2.2 times! It 's
| actually pretty comparable to someone having naive guesses of
| 75% CPR survival vs 30% without CPR. (My actual guess was
| that CPR made a difference about 20% of the time, so _all_
| these numbers are way better than that.)
| beams_of_light wrote:
| I guess we're in a state where any reporting is meant to change
| behaviors?
| George83728 wrote:
| When the American Red Cross trained me in CPR, they told me
| this statistic, and told me that the reason they told me this
| was so that I wouldn't blame myself if the victim dies anyway
| (the most likely outcome.)
| jeffrallen wrote:
| This was true in a recent Swiss training as well.
| ghostpepper wrote:
| They link a study where they polled people shortly after a
| family member was admitted to the ICU about the effectiveness
| of CPR.
|
| My partner is a nurse, so I already knew that the odds of
| community-delivered CPR were about 10% (although now I'm
| curious how those odds change when an AED is available) and
| about the cracking of ribs.
|
| I think what this article could've emphasized more is that more
| people should learn about and consider Advance Directives and
| DNR (do not resuscitate orders), particularly for patients who
| are nearing the end of their natural life.
|
| As it reads now it seems to suggest that bystanders should not
| bother doing CPR in the community, which I think is incorrect
| and borderline dangerous advice.
| Gordonjcp wrote:
| > (although now I'm curious how those odds change when an AED
| is available)
|
| AEDs are fucking magical.
|
| They even talk to you to tell you how to use them.
|
| If the need arises, get the AED and get going.
| koheripbal wrote:
| Isn't an AED only useful for tachycardia? I'm case of
| drowning, heart attack, or most other causes of a stopped
| heart, it isn't useful, correct?
| dreamcompiler wrote:
| Vtach and Vfib are the two shockable rhythms. Those are
| common in many medical emergencies. Just because the
| patient doesn't have a feelable pulse doesn't mean they
| have "flatlined" and don't have a shockable rhythm! You
| have to put the AED electrodes on their chest to be sure.
|
| If the patient has truly flatlined (asystolic) then
| shocking them won't bring them back. That only works in
| the movies.
| tux3 wrote:
| I think AEDs can also pace these days if it's brady (but
| not asystole)
| JshWright wrote:
| I'm not aware of any AEDs that will pace. There are
| devices that can function as both an AED and an external
| pacer. Most cardiac monitors used in ambulances have an
| AED mode that can be used by EMTs, in addition to the
| more advanced features (transcutaneous pacing,
| cardioversion, manual defibrillation, etc). Those are the
| sort of thing a layperson is going to come across as an
| "AED" though.
| tialaramex wrote:
| The AED does not restart hearts, it can't do that, the
| shock disrupts an abnormal rhythm, allowing the restart
| to potentially take place automatically. But if your
| heart has _actually_ just outright stopped, you are
| basically dead.
|
| Clinicians report as little as zero success for patients
| in asystole (ie their heart has plain stopped). Some
| studies report a little higher, but it's also possible
| those rates are mistaken diagnosis, ie you see a flat-
| looking ECG, you treat anyway, maybe 1% of patients
| survive - but maybe that 1% were actually not really in
| asystole.
|
| If you have a heart attack, both an AED and CPR are
| inappropriate, your heart is still working it's just that
| the blood isn't going where it's needed. You need
| immediate medical treatment. While an actual cardiac
| arrest (which would warrant an AED and CPR) is much more
| likely during a heart attack, it is not inevitable and
| these treatments are _not_ prophylactic. Meanwhile your
| focus needs to be on alerting other people to your
| problem, so that they can get you medical treatment, and
| if you do go into cardiac arrest they can perform CPR or
| use an AED once that becomes appropriate.
| dreamcompiler wrote:
| > If you have a heart attack, both an AED and CPR are
| inappropriate
|
| This is a phrase that's easy to interpret in a
| dangerously wrong way. Here's a clarification:
|
| If you have a heart attack _and are still alive and
| talking_ , both an AED and CPR are inappropriate.*
|
| If you have a heart attack _and die_ , then both an AED
| and CPR are _very_ appropriate and might bring you back.
|
| * And even in this case the emergency response medics
| _will_ put AED electrodes on your chest so it will be
| ready to use in case you crash.
| josephcsible wrote:
| > you see a flat-looking ECG, you treat anyway, maybe 1%
| of patients survive - but maybe that 1% were actually not
| really in asystole.
|
| Isn't that basically the no true Scotsman fallacy?
| tedunangst wrote:
| False positive paradox.
| tialaramex wrote:
| Maybe?
|
| Sometimes, when our measurements differ from what we can
| explain with our understanding of the universe, that's
| because we didn't understand the universe properly. If
| you put the Sun in the middle, your model of the solar
| system is still weird nonsense with planets on their
| circular orbits needing to swing backwards or accelerate
| forwards for no reason - until you make the orbits
| _ellipses_ instead and then it 's almost like fucking
| clockwork.
|
| But sometimes, you were just right, and the measurements
| were off a bit, and there was no real physical
| phenomenon, you were just bad at measuring.
|
| So, maybe sometimes the human heart does actually stop,
| yet it can successfully be restarted and then carry on as
| normal, and the circumstances where this is true are just
| fairly uncommon and when people are peering very
| carefully at the results they never ran into one of these
| rare cases. I cannot rule that out.
| User23 wrote:
| Right. Doing nothing has a near zero recovery rate for cardiac
| arrest.
|
| Any intervention needs to be judged against the real
| alternatives and not some imaginary ideal case.
| williamDafoe wrote:
| The real point of CPR is to bridge their life while you rush to
| get them an AED. Without the AED the chance of their heart
| restarting permanently is vanishingly low ... Last few times I
| had first responder training it was said to be less than 15%
| chance of survival for a patient given CPR, and you'll only hear
| about this if you ask.
|
| The last time I had first responder training the guy sitting next
| to me was drowned by a surfing accident but it was his great
| fortune that on shore there was a national expert giving rapid
| water rescue training and they had this guy out of the water and
| his heart restarted in 5 minutes. So that is why he was taking
| first responder training himself!
| User23 wrote:
| Thumpversion sometimes works too. Interestingly it was also
| invented by Dr. Bernard Lown, who is best known for inventing
| the DC defibrillator.
| robbiep wrote:
| It almost never works, unless you are seeing a witnessed
| cardiac arrest and know how to administer. That is the right
| 'indication' for a precordial thump, but the success rate is
| still terrible.
| randcraw wrote:
| "An international team of researchers looked at 49,555 out-of-
| hospital cardiac arrests that occurred in major U.S. and Canada
| cities. They analyzed a key subgroup of these arrests, those that
| occurred in public, were witnessed and were shockable. The
| researchers found that nearly 66 percent of these victims
| survived to hospital discharge after a shock delivered by a
| bystander."
|
| https://newsroom.heart.org/news/cardiac-arrest-survival-grea...
|
| Obviously, 66% beats the 10% survival rate in the original
| article (getting CPR alone from bystanders). The takeaway: AEDs
| can make a BIG difference. Curious that the article failed to
| mention that.
| LorenPechtel wrote:
| Also, a witnessed arrest likely means it's because the heart
| stopped vs the heart could no longer operate because of other
| problems. Also, vfib is far more salvageable than not operating
| at all.
| tinus_hn wrote:
| There's a curious movement of people who spend their life
| afraid they will 'endure' CPR and live to tell the tale. And
| they come up with scare pieces like this one.
|
| Sorry, if you go as far as getting a tattoo because you're so
| afraid you will be resuscitated, you're in way over your head
| and it's time to focus your energy on something constructive.
| zdragnar wrote:
| There's at least a small skew in the numbers as well. My wife was
| instructed to perform CPR by a 911 dispatcher on someone she
| found who had died in their sleep, and kept talking her through
| the instructions until paramedics arrived.
|
| I'm assuming this is counted in the broader "survival rate"
| numbers. That's not to say that the overall message is wrong, but
| CPR being administered to the dead, or those in medical distress
| who wouldn't benefit from it, will obviously decrease the overall
| effectiveness scores.
| spacechild1 wrote:
| I didn't know about the low success rate of CPR, but I have been
| very well aware of the potential damage. When I was a paramedic
| (as an alternative to military service) I once had to perform CPR
| to an old lady and I heard her rips crack. One of the worst
| experiences in those 9 months...
| markoman wrote:
| You're kinda burying the lede here... Was this woman
| resuscitated by your efforts and do you know how long she
| survived afterwards?
| lotsofpulp wrote:
| *and with what quality of life did she survive?
|
| If I am 85 years old, maybe it is better for me to move on.
| EA-3167 wrote:
| CPR + Old Lady + Not in a hospital = Almost certainly didn't
| survive, or live well if she did.
| mikepurvis wrote:
| Yeah, that's what I got from lifeguard training. The best
| chance of doing anything positive with it is going to be on
| an otherwise young and healthy person whose heart stopped
| due to a very unusual trauma.
|
| And CPR and artificial respiration is never a miraculous
| eyes-opening recovery like in the movies-- it's pretty much
| just putting oxygen in the brain to buy a few extra minutes
| for the ambulance to arrive and take over.
| spacechild1 wrote:
| Correct :-(
| EA-3167 wrote:
| I'm sure you did everything you could, the sad fact of
| life is that eventually it ends.
| spacechild1 wrote:
| Ah, sorry! I heard afterwards that she was declared dead when
| she arrived in the hospital...
| lkbm wrote:
| I was taught that if you aren't breaking ribs, you're doing it
| wrong.
| karagenit wrote:
| I don't think that's right. Sometimes the cartilage will
| break which can sound similar, but broken ribs is a serious
| condition that can lead to internal bleeding and such.
|
| > Broken ribs are present in 3% of those who survive to
| hospital discharge, and 15% of those who die in the hospital
|
| https://en.m.wikipedia.org/wiki/Cardiopulmonary_resuscitatio.
| ..
| lkbm wrote:
| Ah, this was something like ten years ago, so it seems
| likely that I'm misremembering. Thanks for the correction!
| contingencies wrote:
| I was taught you are supposed to break the cartilage.
| null-shell wrote:
| My father two years ago had a heart attack and a stroke, I found
| him and yelled for my mom and sister, then started CPR until the
| paramedics came. He survived and is doing very well, but it's
| crazy to think there was only a 10%~ish chance of it working.
| aaron695 wrote:
| [dead]
| mjevans wrote:
| Salient data from the article:
|
| TL;DR CPR slightly increases the odds for someone otherwise
| healthy and young but is much less effective for the old and the
| chronically ill.
|
| IIRC from prior CPR classes (own life data), 'correctly done'
| chest compressions are extremely violent, they often break ribs
| to get that compression of the heart between the rib cage and
| spine. It's a last-ditch effort with COSTS. If there's an AED
| around to use instead that would be FAR more preferable.
|
| """ But the true odds are grim. In 2010 a review of 79 studies,
| involving almost 150,000 patients, found that the overall rate of
| survival from out-of-hospital cardiac arrest had barely changed
| in thirty years. It was 7.6%.
|
| Bystander-initiated CPR may increase those odds to 10%. Survival
| after CPR for in-hospital cardiac arrest is slightly better, but
| still only about 17%. The numbers get even worse with age. A
| study in Sweden found that survival after out-of-hospital CPR
| dropped from 6.7% for patients in their 70s to just 2.4% for
| those over 90. Chronic illness matters too. One study found that
| less than 2% of patients with cancer or heart, lung, or liver
| disease were resuscitated with CPR and survived for six months.
| """
| starwatch wrote:
| > 'correctly done' chest compressions are extremely violent.
|
| For a good visual of this take a look at a LUCAS machine in
| operation [1]. I'm a (retained) firefighter and have seen
| paramedics deploy a LUCAS - it's quite a thing to behold.
|
| > If there's an AED around to use instead that would be FAR
| more preferable.
|
| Sadly AED's aren't always appropriate. They need a "shockable
| rhythm" - that is if your heart is in ventricular tachycardia
| or ventricular fibrillation [2].
|
| One interesting fact I recall reading (source long forgotten
| ...) is that collapsed women are less likely to be helped with
| AED's by passers by. This is because they feel uncomfortable
| uncovering the chest to apply the AED pads.
|
| [1]: https://youtu.be/G-oPJV1LYaE?t=314
|
| [2]: https://www.mayoclinic.org/diseases-conditions/heart-
| arrhyth...
| dreamcompiler wrote:
| This is why you cannot learn CPR by watching people do it on
| TV. The actor playing dead would be seriously injured if they
| were receiving _proper_ CPR.
| deanCommie wrote:
| Holy shit...
|
| I had _read_ that chest compressions for CPR are much more
| aggressive than people imagine and rips being broken is not
| uncommon.
|
| The first few seconds of that clip though made me physically
| wince with discomfort... wow!
| EA-3167 wrote:
| This is sadly true, a friend and colleague of mine passed
| away about 7 years ago from sudden cardiac arrest. There was
| an AED in the building, but unfortunately he was in asystole,
| nothing there to shock.
|
| Having said that AED's do save a lot of lives, but like CPR
| they aren't magic.
| Eji1700 wrote:
| I swear this comes up every 2-5 years. It's insanely violent,
| doesn't work as well on the elderly (like literally everything
| else), and is still better than nothing. Things like this
| almost feel like fear bait. It's intuitive that a procedure
| performed on someone who's dying is ALWAYS going to be less
| effective on the elderly. So long as it's not killing more
| people than it helps (extremely unlikely given the whole
| "you're not breathing/your heart has stopped" qualifier) it's
| still an important thing to know.
| henry2023 wrote:
| About 93% of the time it's worst than nothing.
| mjevans wrote:
| For bystanders, the raw numbers from the article reflect a
| 7.6% survival rate became a 10% survival rate. An absolute
| improvement in about 24 out of 1000 cases, though for those
| that do 'survive' maybe a 33% increase?
|
| Though those numbers strongly hint at over simplified
| variables. Is there other medical help available? (E.G. an
| AED, maybe combined with CPR?) Is EMS close? Are they near
| a medivac capable landing site and a level 1 trauma center?
| How does this change across patient demographics?
|
| For my own health, this goes back to end of life management
| questions, can I recover or even improve to a degree if a
| procedure is done? As someone with hopefully decades and
| maybe even a chance at upload or archival if I live long
| enough CPR probably is worth it for the cases where
| survival is improved; but only if all the other options are
| exhausted first.
| dghlsakjg wrote:
| The doing nothing treatment leads to death 100% of the time
| since you don't do CPR on people with a beating heart.
| pessimizer wrote:
| _Slightly_ worse than nothing; saves a tiny bit of exercise
| for someone. 7% of the time it saves a life.
| michael1999 wrote:
| Quality of life is not a boolean variable. "CPR-induced
| consciousness" sounds like a truly terrible way to go, and
| likely to cause real suffering in the practitioner/torturer.
| SapporoChris wrote:
| My nephew performed CPR on my mother (his grandmother). It
| wasn't successful, he gets to live with the psychological
| consequences. I imagine not acting would have worse
| psychological consequences, but only because society has
| built up unrealistic expectations regarding CPR.
| frederikvs wrote:
| > If there's an AED around to use instead that would be FAR
| more preferable.
|
| AEDs still require chest compressions. In fact, they'll give
| you rhythm to follow and talk you through it.
|
| I would expect a very similar rate of injuries from
| compressions - perhaps a bit less if the AED means the
| compressions don't need to be performed for the same length of
| time.
| hnthrowaway8860 wrote:
| If you are ever in the situation, what will you do?
|
| I will certainly peform CPR. Even after reading the article.
| Why? Most likely the person is dead anyway, no harm done. But
| if I don't do it, chances are their family sue me for millions.
| Especially in the US. Unlikely to succeed, but the risk is far
| from 0. If they win, my life is ruined. I the face of that, I
| might even consider a settlement for a large sum. Also
| terrible. So yeah, sorry old ladies.
|
| Such articles, a much as I appreciate the educative effects,
| could even make this worse, since if it's more widely known
| then I could get sued in either case. Like, I did CPR, lady
| dies anyway but there were clear signs that she suffered.
| Great, now I'll have a lawsuit in addition to the trauma of
| having crushed the ribs of an old lady.
| mjevans wrote:
| I'm not really fit enough to compress properly, nor have I
| been in CPR training recently.
|
| In an emergency my support role would be better spent on
| comms support or managing other trauma.
| asdfjasgoinio wrote:
| >If there's an AED around to use instead that would be FAR more
| preferable.
|
| This is dangerously wrong. Availability of an AED does _NOT_
| eliminate the need to know CPR.
|
| A defibrillator is useful only for certain types of heart
| rhythm, namely v-tach and v-fib. It is of no use whatsoever for
| other rhythms. The AED itself will detect the type of rhythm
| and will only administer a shock if it is indicated. If the AED
| does not detect a shockable rhythm, the machine instruct the
| user to perform CPR.
|
| https://www.proacls.com/wiki/acls-algorithms/shockable-rhyth...
|
| Even if an AED is available, it will not arrive immediately.
| Even a short lapse in chest compressions can cause lasting
| damage. It is necessary to give CPR for even the few seconds
| until the AED is connected.
|
| https://www.redcross.org/take-a-class/cpr/performing-cpr/cpr...
| three14 wrote:
| Complete anecdata, but a few months ago a neighbor of mine
| successfully resuscitated another neighbor with CPR. There was an
| AED present, but from what I heard, it did not recommend a shock.
| The person who collapsed is around 70 years old. Sometimes, it
| does work! There clearly are some cases where it would be crazy
| not to try it.
| JshWright wrote:
| CPR alone is very, very unlikely to reverse cardiac arrest.
| It's possible your neighbor lost consciousness, but wasn't
| actually without a pulse, and CPR just woke them up.
| dheera wrote:
| I'm a survivor of cardiac arrest and was resuscitated with an AED
| and CPR. I've gone through a lot but I'm glad to be alive, have
| an implanted ICD now, and I'm glad some employee didn't refuse to
| do CPR on me.
|
| I wasn't conscious for the event and the entire following week,
| but they didn't break any of my ribs. Maybe the AED allowed them
| to be less violent.
| zahma wrote:
| Sounds like you were fortunate to have multiple people around,
| an AED nearby, and someone well-trained. You're probably right
| that AED helped prevent physical damage, though that may also
| be due to good technique and or your anatomy. The sooner that
| the AED goes on and restarts sinus rhythm, the fewer
| compressions required.
|
| Happy to hear you are doing better.
| dheera wrote:
| Yep it happened at a boat race, so there were paramedics
| already on-site. On one hand I was told to avoid competitive-
| intensity sports in the future, but I was also super
| fortunate that it all played out at a boat race and not while
| climbing some mountain. And having the ICD means I can still
| hike non-strenuous mountains.
| anonymousiam wrote:
| I was dead on the street at 15 after being hit by a car (my
| fault). A good Samaritan stopped, administered CPR and
| resuscitated me. Forty six years later and I never got to thank
| him. I only know his first name (Mark).
|
| CPR is a good thing and hopefully this article will not make
| people think twice before administering it.
| SkyPuncher wrote:
| One of the most interesting insights I learned, second-hand
| from my wife's medical education, is the essentially bi-modal
| distribution of CPR need. Note: This is an observation based on
| memory. It may or may not be actually true.
|
| * Group One is people like you. Otherwise healthy people who've
| had some sort of crazy event. CGR gets your body through an
| acute moment so it can heal and recover on its own.
|
| * Group Two. People that are already sick or very sick. Cardiac
| arrest is essentially their body failing. Even if CPR is
| successful, they're have lots of physical trauma that is
| extremely hard to overcome. Another cardiac arrest is
| inevitable.
|
| The article does a terrible job of identifying this difference.
| If you're a member of the general public and you need to give
| CPR, there's a huge chance you're giving it to someone in Group
| One. Most people in Group Two are already hospitalized or in
| some sort of care setting.
| sebii wrote:
| This distinction was my take away from the article.
| LorenPechtel wrote:
| I think there are really three groups:
|
| 1) Healthy people, heart stopped by some traumatic event.
| Survival odds good.
|
| 2) Reasonably healthy people, heart attack. Moderate survival
| odds.
|
| 3) People who were already sick. Odds low, success likely
| isn't worth it.
| snowwrestler wrote:
| Yes this was a point of particular emphasis in swiftwater
| rescue classes since drowning is one of the mechanisms of
| injury for which CPR can work well to bring someone back who
| appears dead (not breathing, hard-to-find pulse).
|
| It's also a scenario in which the breathing part of CPR is
| particularly valuable. A lot of front-country CPR courses de-
| emphasize administering breaths in favor of sustaining chest
| compressions.
| iudqnolq wrote:
| > Most people in Group Two are already hospitalized or in
| some sort of care setting.
|
| No. Disabled and sick people are all around you. This is why
| you should have been taught in your CPR class to check for a
| medical ID tag that might, for example, say that the person
| doesn't want to be resuscitated.
|
| Also just because someone is disabled doesn't necessarily
| mean they don't want CPR. That's their choice and not yours,
| just respect it. Denying disabled people CPR without consent
| during the pandemic in the UK and Canada did significant
| damage to public education around when you might want not
| want CPR.
|
| I learned CPR on a Wilderness First Responder course. They
| keep adding more medical training because the wilderness is
| increasingly accessible to disabled and sick people. The
| sidewalk in the middle of civilization is much easier to get
| to than that.
|
| Edit: This is a reason however to continue CPR longer in
| certain cases like drowning (especially in cold water) and
| lightning strikes.
| scythe wrote:
| >Disabled and sick people are all around you.
|
| You are conflating "disabled" with "dying". A deaf person
| will have a decent chance of coming back to normal if they
| survive CPR. An 85-year-old with heart disease will most
| likely not. The parent was a little vague, but if you read
| the article the context is clear.
| iudqnolq wrote:
| Do you believe most 85-year-olds with heart disease are
| in a hospital and not in public?
|
| Edit: Furthermore the person I replied two defined group
| 1 as "otherwise healthy". So I think it's fair for me to
| have inferred they meant what they said and their only
| other group includes "sick and very sick" people.
|
| Edit2: Realize I had a significant typo. My post was
| phrased as a statement and not a question. I added the
| "Do [original]?"
| cstrahan wrote:
| Can't you be both deaf and healthy? Or missing a leg and
| healthy? I don't see how "disabled" implies "not
| otherwise healthy".
|
| I often run into people who are deaf, or an amputee, or
| have type 1 diabetes, etc, but I rarely come across
| someone that (to my knowledge) has a substantial illness.
| But I live in a city where I very, very rarely run into
| someone much over 40 (at that point they are likely to
| have been married and had children, and the thing nearly
| everyone does here is move into the suburbs once they're
| married with children).
|
| I suspect that where you live makes a huge impact on
| whether or not you're surrounded by unhealthy/ill people.
| iudqnolq wrote:
| You may not run into people over 40. But most people over
| 40 absolutely live in ordinary communities.
|
| The original point I replied to suggested everyone at a
| high risk for bad CPR outcomes is in a hospital. Now
| we're talking about suburbs.
| bb611 wrote:
| I think your comment isn't being well received because it
| represents fairly stark national differences.
|
| In the US, a DNR is primarily for a medical setting with
| staff who've already identified you and confirmed its
| veracity. Withdrawing medical care creates massive
| liability so providers are going to make sure they got it
| right before stopping. Lay people do not have the knowledge
| to make these kinds of decisions.
|
| I've never been taught to even check for a bracelet during
| any of my CPR trainings, and my wife who's been an EMT for
| 10 years tells me they will still run the code after being
| presented a DNR until until they receive a clear
| confirmation from their medical director to cease.
| iudqnolq wrote:
| I'm from the US. I've definitely heard US EMTs talk about
| ignoring DNRs. I think that's pretty unethical.
|
| I was taught in the US to check for a medical ID tag.
| You've already covered the locations for one bracelet and
| a necklace during your pulse check. You'll want to know
| if your patient, for example, caries an EpiPen for a
| serious allergy.
|
| DNRs are underutilized in the US. As this article points
| out CPR might not be worth it even if you aren't in
| hospice care. A DNR would invalidate implied consent so
| technically doing CPR after seing a DNR tag would be
| assault.
| smorrebrod wrote:
| Yes, the article says that half of the people resuscitated by
| CPR wished it didn't happen. The linked paper explicitly says
| this figure is valid for in-hospital administered CPR, so
| definitely people belonging to group 2.
| stefantalpalaru wrote:
| [dead]
| jeroenhd wrote:
| The risks and problems are a lot worse for old people than for
| teenagers. The story in this article is allot more complicated
| than "Don't try to revive toddlers or always revive comatose
| 110 year olds". As important as CPR is, people who will be
| performing it deserve to know 9 out of 10 people will still end
| up dead. Nobody gains anything from a bystander blaming himself
| for the death of someone they could never have saved.
|
| For many survivors, life after CPR is a gate worse than death.
| I'll try to apply CPR should I ever need to, but if I were to
| end up a vegetable or permanentlysufferimg husk like so many
| people, I'm pretty sure I'd be begging for euthanasia if I
| still can.
|
| I may not agree with their decision, but I understand why the
| nurse in the story may have refused. If I get to live to a ripe
| old age, I'd get whatever do-not-recussitate paperwork I might
| need.
| lamontcg wrote:
| > I was dead on the street at 15
|
| Big difference between 15 and 85 or 95.
| riceart wrote:
| Successful resuscitation after traumatic arrest is extremely
| rare. It is more rare than bystander field CPR administered to
| those that are not in actual arrest (unconscious but with a
| perfusing rhythm).
|
| What was the confirmation of arrest? I have been called
| numerous to bedside for in hospital "arrest" that turned out to
| be assessment error - that is with trained medical
| professionals.
| samtho wrote:
| The value of CPR by is rarely derived from successful
| resuscitation. In most cases, the person performing CPR is
| someone who was trained briefly on chest compressions and
| mouth-to-mouth which to be performed until a EMT arrives or
| an AED becomes available. The purpose of this procedure is to
| get some, however small, bit of oxygen into the patient to
| prevent brain damage.
| [deleted]
| whatever1 wrote:
| That is why statistics are a horrible tool for decision making.
|
| There are so many things that on a statistical basis make no
| sense. Yet on an individual level it is a life-or-death
| difference.
| jdietrich wrote:
| > That is why statistics are a horrible tool for decision
| making.
|
| Statistical illiteracy is a horrible tool for decision
| making. Statistics is the _only_ tool for decision making
| other than pure guesswork, because all decisions based on
| data are statistical inferences. If something doesn 't make
| sense on a statistical basis, it's almost certainly the case
| that the statistical analysis was naive.
|
| A statistical inference of the probability of survival of a
| particular patient that doesn't take into account any
| characteristics of that patient is naive in the extreme. We
| aren't interested in the average patient, we care about the
| average patient _whose risk profile most closely resembles
| our patient_.
| ransom1538 wrote:
| I took CPR class quite a few times. One thing I learned, if
| they are young, there is a good chance it will work. If they
| are old, there isn't much hope.
| FireBeyond wrote:
| As a paramedic, somewhat. It's also to do with how -quickly-
| CPR starts. What -typically- happens (though by no means
| always) is the heart goes from a normal sinus rhythm to VT
| (ventricular tachycardia) to VF (ventricular fibrillation) to
| asystole / PEA (pulseless electrical activity) or similar.
|
| Now by all means getting ROSC (return of spontaneous
| circulation) back doesn't mean everything is golden (indeed
| many patients re-arrest between home and the hospital),
| because we haven't fixed the underlying cause (plaque in the
| arteries, etc.)
|
| But similarly, many younger or young adult arrests are often
| due to congenital defects or issues, diagnosed or not. We
| obviously don't fix that in the field either.
|
| Where your statement is definitely much more true is in
| pediatric arrests. The vast majority of pediatric arrests are
| respiratory arrests that deteriorate into cardiac arrest - be
| it FBAO (foreign body airway obstruction), near-drowning, or
| similar. If we can fix the root problem - dislodge that
| foreign body (either by removal, or from the force of
| compressions), or at least allow enough air through, either
| naturally or by ventilation, to get to the lungs and re-
| perfuse the blood, we can usually get ROSC and, because we
| -have- "solved" (temporarily or otherwise) the root cause,
| those patients, thankfully, tend not to re-arrest.
| throwaway049 wrote:
| Trauma arrest has a particularly low survive-to-discharge rate
| so you beat the odds. Speaking as an EMT, we will make every
| effort anyways - we like beating the odds too!
| blastro wrote:
| CPR saved my dad's life as well
| n8henrie wrote:
| CPR successfully resuscitating a traumatic arrest is _highly_
| unusual. Consider yourself anomalously lucky.
| JshWright wrote:
| Especially CPR alone. Assuming a defibrillator wasn't used,
| there's a non-zero chance this wasn't actually a cardiac
| arrest, but rather a loss of consciousness and the bystander
| couldn't find a pulse that was actually present (finding a
| pulse in a high stress situation is not at all easy to do).
| gerdesj wrote:
| It is a good thing: obviously - you were resuscitated.
|
| I did a first aid course a few months back and one of the
| attendees (six in total) had done a similar job for a colleague
| a few years back. Their description was quite something. To be
| told first hand what happens, corroborating the instructor is a
| lesson and a half. It isn't pleasant at all and I won't spell
| it out here. As well as CPR we covered quite a few other things
| and you are far more likely to encounter choking and the
| correct response is far more likely to have a good outcome than
| CPR, so first aid courses are a very good thing.
|
| If I end up having to deliver CPR, I will do it without
| hesitation. I will do the checks first, mindful that I will be
| performing what amounts to ABH. A small success rate is better
| than nothing.
|
| OK so something like 5-10% is the real success rate for CBR.
| Now, would you be interested in something like 75%?
|
| DEFIBRILLATOR.
|
| A defib will talk you through how to use it but a short course
| will get you going much quicker. They are just like jump
| starting a car but instead of croc clips, the wires are
| connected to sticky pads that you stick on the person. They are
| battery powered and can be very small and portable. They are
| nothing like as big as you see on old school TV dramas.
|
| Upside: ~75% chance of resuss. compared to around 5-10% for
| CPR. No need to potentially break ribs or other unsavoury side
| effects of battering a person. Downside: Costs around PS1000 a
| pop - they are reusable.
|
| If you own a business, why not grab one, slap it on the wall
| near to the first aid kit and get the staff clued up. When you
| get to a certain age (over zero) why not get one at home?
|
| I have not yet followed my own advice yet but I think I will
| quite soon! Have a chat about it with your staff, family and
| whoever will listen.
|
| I think that CPR should be likened to camping without a tent,
| in the Arctic. A defib: glamping, with free Cava! That said, I
| will still cause ABH on someone that I deem needs it if nothing
| else is to hand.
| quantumwoke wrote:
| I appreciate the exuberant tone of this message but it's not
| quite correct. Defibrillators can get upwards of 60% success
| rate if given in conjunction with effective CPR. There's no
| getting around breaking ribs - defibrillators have to charge,
| you have to check the pulse and oxygen has to be given. You
| can't leave someone pulseless for 60 seconds while you fetch
| and charge the defibrillator as they will die. All the first
| aid tools are used in concert.
| JshWright wrote:
| >There's no getting around breaking ribs
|
| You're usually "just" dislocating the ribs from the sternum
| (and often tearing the cartilage at that joint). Doesn't
| feel any less crunchy though...
| groestl wrote:
| Also, there are shockable and non-shockable heart rhythms.
| A defibrillator is not a catch-all solution.
| KineticLensman wrote:
| (I have Ventricular Fibrillation and have been de-fibb'd
| twice, the second time by an implanted device).
|
| Exactly! Defibs can't restart a 'stopped' heart. They
| instead resynchronise the muscle fibres when the heart's
| internal rhythm has got messed up for whatever reason.
| They can (try to) fix a heart that is quivering rather
| than beating cleanly.
|
| But the defibs themselves can sense the difference and
| won't apply a shock if the rhythm isn't shockable. You
| should always get one out and let it try to shock if it
| can.
|
| Coming back to the main point, when I had my first VF
| episode, CPR kept me alive long enough for the staff at
| the place where it happened to find their defib. The
| doctor at the hospital who implanted my ICD told me that
| surviving an out-of-hospital cardiac arrest was something
| like a 1 in 5 chance. The surgical team were clearly of
| the view that I was very lucky to be there. And, yes, I
| got broken ribs. This was the most painful thing. I had
| too sleep sitting up because getting up from lying gown
| was too painful. Sneezing (and laughing) were also fairly
| painful. But a small price to pay.
| mullingitover wrote:
| I think they work best in combination. The CPR can keep your
| brain alive long enough for the defib to arrive.
| cykros wrote:
| Indeed. They've been available on Amazon since Amazon was
| still known so much as a book store that it made headlines
| that you could get them there, what with their not being
| books and all.
| angrygoat wrote:
| +1 on doing a first aid course. It's a day or two, it's
| interesting, and it's a good thing that human beings should
| be prepared and willing to help one another.
|
| I'm 41 and I've now twice encountered a situation where I
| should give first aid. The first time was a fatal collision
| between a bicyclist and a pedestrian, in an affluent suburb:
| there were actual doctors working on the pedestrian, so after
| checking an ambulance had been called, I left - no point in
| gawking.
|
| But I was struck by how little I could have done to help if
| I'd encountered the accident by myself. So I took a first aid
| course as soon as I could.
|
| A few years later I was cycling and came across a fellow
| rider who'd come off and landed on his head; he was just
| lying there in the path. It was amazing how the training
| kicked in - I checked for danger to myself, established he
| couldn't respond to me, established he was breathing,
| carefully put him in the recovery position, used my bike to
| wall him off a bit so nobody would ride over him, then went
| for help (I didn't have a phone on me, the one time I
| happened not to have it!)
|
| The injured cyclist was fine in the end, he came around after
| a few minutes and it was then a matter of persuading him to
| wait until the ambulance folks arrived; he had no concept
| that he'd been out for multiple minutes, I think from his
| perspective it had only been a moment. I'm glad I was able to
| help though. So yeah, if you are able, do a first aid course.
| aaron695 wrote:
| [dead]
| richardjam73 wrote:
| You can now get single use defibrillators that are cheaper
| but they have a limited life span.
| cmcaleer wrote:
| All defibs do. The battery and pads need replaced every few
| years.
| sokoloff wrote:
| I read this brief but powerful related story of compassion and
| leadership last year and feel like it's worth sharing here:
|
| https://twitter.com/tjwebbmd/status/1557229120131588098 (warning:
| covers aspects of the death of a young child)
___________________________________________________________________
(page generated 2023-05-30 23:02 UTC)