CPR: Does it Really Keep You "Stayin' Alive"?

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37 years in EMS, 33 as career firefighter-Paramedic in a suburban setting. Surviving a CPR event to walking out of hospital is so very low. So many different renditions of AHA protocol’s of CPR and the medications used, really made no difference, unless, good hard and fast bystander CPR was started and an AED was used within the first 5 minutes. The Down time is the bummer of nature. When did the heart really stop pumping? 5 minutes passed the last, blood pressure producing heat beat is the point when devastating brain damage happens. Not to mention when does the Patients Cyclic ATP stop working? In my experience, the Unknown down time CPR patient’s rarely leave the hospital being more than technically alive. Although, the Heart muscle itself can be kick started with enough Epi, vasopressin, shocks, CPR, but the brain is the key factor in all of it. I feel that the general public needs to taught the reality’s related to death events. 1. Death happens despite best efforts and wishes of the living. 2. Being taught the signs and symptoms of: AMI, PE, AAA, and CVA and what to do if you or a loved one have those symptoms, might lead to a longer life for you or that person. 3. Learning good CPR, and Basic First aid skills might save a life.

My grandmother had CPR and suffered broken ribs in her late seventies. It was delightful to hear her complain of rib pain for two months and to hear her for years and years thereafter, alive. Everyone who is able, please take and maintain CPR education.

My 93 year old mother refused to sign a DNR. When the Dr explained that she may have broken bones if she has CPR. She said..."No, I don't want that." So if your heart stops you don't want CPR? She said, "of course, if my heart stops." Just saying, most elderly don't understand.

This is a good reminder to us all. I'm a retired career RN with years of ACLS. In that terrible moment when my husband postured seated next to me in the car, in the middle of nowhere , I drove like a bat out of hell to a tiny community. It was there that I evaluated him. No pulse. I knew that to stop on a dirt road alone and attempt CPR was futile. I remembered these studies while I was driving. Even though I live with a level of guilt for not having tried, I know it was the correct decision.

To reduce the incidence of broken ribs... the mechanical engineer in me wants to propose that chest compressions be done by pressing the sternum NOT straight perpendicular inward, but instead on a downward angle toward the navel. This would achieve the same amount of volume change in the chest cavity, but would do it by letting the ribs rotate downward more (which is how the rib cage normally works) and flex/ bend less (which the rib bones are NOT built for). This angle of action puts less of those fracture-causing stresses on the rib bones. Medical and CPR instructors like to have students understand the ribs as leaf springs that flex (bend) to change volume in the chest cavity, but this is not mechanically correct: No place in nature do bones ever evolve for the purpose of bending. How the rib cage actually works is that the soft ligaments anchoring both ends of each rib allow the ribs to rotate up and down, thereby changing chest cavity volume. Any reasons why this proposal might not work a lot better? It would be way more clear to draw a diagram instead of trying to describe it with all these words.

Before I retired I had OSHA mandated CPR training every two years. We got the short form of what you presented, but with a broader view. Don't exceed the limits of your training, activate EMS (call 911) first, turn to an AED if available - safer and more effective, and once CPR is begun it can only be ended if the patient regains heartbeat, or you are relieved, or are exhausted. It was clear an AED doesn't help if the heart is [edit: not] in fibrillation, but it wasn't clear if CPR would help a quivering heart. However, I may have saved a life or two before they needed CPR. The most recent one was our 50ish contracted mail delivery guy. He arrived one morning about 8:30, sweating profusely on a cool morning. He seemed exhausted and said the phrase that makes my hair stand on end: "I don't feel good." I asked what I always ask when somebody says that: "What kind of don't feel good?" He said he didn't sleep well - another common complaint for people having heart attacks - and blamed that for his ill health. He said he was barely able to make it the three steps up to the building next door. I urged him to call 911 but he wouldn't hear of it, so I called my boss and he arranged to have him diverted to the nurse at his next stop. I don't know any more but I never saw him again. I can only hope, but no broken ribs and a better chance of survival.

The biomechanics of doing CPR on a floor as opposed to a hospital bed is significant. When I did CPR on a moving gurney I was almost always stretcher surfing with my partners handling the stretcher. CPR is physically much easier if the patient is lower to the ground, and I don't think hospital beds drop that low. If the patient is very large and the person doing chest compressions is small, they need all of the height advantage they can get. If they are standing on the floor I think it would be hard to maintain proper positioning unless the bed or gurney were lowered a lot. At the time I worked in EMS I was in better shape and did some occasional pushups.

Unfortunately, most physicians where I'm at employ CPR not as a bridge but as a knee jerk reaction. They also order things not for their diagnostic-therapeutic value but as litigation barriers.

Unless you live in Seattle where you must know CPR to graduate high school, out of hospital saves are rare...former NYC EMS Paramedic. Combination of no bystander CRP and average EMS arrival to the door, not the patient, exceeds 6 minutes. The patient, unless young and healthy is already brain dead before CPR is started. Sad

I’ve worked many codes -- and prefer to let my body and soul go gently when my time comes -- ribs and lungs intact.

Maybe we should show patients videos of what it looks like. It would be easy enough. But certainly the topic deserves more than the 10 seconds typically devoted to it!

Dr Glaucomfleckins wife did 10 minutes of compressions at home with 911 on the phone and he is back to normal. Don't know what his rhythm was but he is a good example of a good save.

Hey Roger, in 2014 my best friend had a massive heart attack at the age of 37 (smoker, history of surviving heart attack at 26 due to being worked 120 hours/week at a newspaper, currently abusively changing schedule that could have him getting up as early as 4 in the morning or coming home at 10 30 at night) He was found in about 10 minutes and given CPR by one of his managers and I spent 3 days with him in the hospital before they said he would never be able to breath again independently even if he regained consciousness and his family said to unplug him. I remember a doctor there said that "91% of out of hospital heart attacks don't survive sadly" and I was so angry at him (although I kept it to myself) I couldn't believe that that was true, and it made me feel like he didn't want my friend to recover. I've known for a long time now it was true.

Very insightful....

This was very interesting. Did not know the rates were that low. I took CPR training. I know it can be brutal. Yet, people desperate to save loved ones, sometimes it works.

Discharged isn't necessarily home, it can be to a " long term care facility ". It doesn't indicate return to normal function.

I survived an Out-of-Hospital Cardiac Arrest 3 1/2 years ago. I was 46 when it happened, which they consider fairly young. It was precipitated by a STEMI caused by an In-Stent Thrombosis on a stent that had been placed 6 1/2 years earlier to open two blockages next to each other in my LAD of 90% and 99% (as opposed to a re-stenosis). My Vtac/V-fib was was witnessed by EMTs and they got me to the ambulance quickly and used a LUCAS device to perform compressions and bagged me because they had trouble intubating. I'm not sure if the EMTs did any manual compressions or just went straight for the machine. The EMTs worked on me in the ambulance outside my home for 20-25 minutes and even had paramedics drive up to help, but each time they shocked me and got me back, they'd lose me again. The fire chief drove up too, and after the third shock failed, he told them to take me to the nearest ER. The ER achieved ROSC somehow. I'm told I received CPR for 40 minutes. It was getting late and this was a small hospital, so they put me into a hypothermic coma and sent me by helicopter to a regional trauma center. They cathed me and aspirated the clot. They told my mother they weren't willing to do anything more invasive and expensive like Coronary Artery Bypass Graft because they didn't know if I was braindead or not. They wanted to bring me out of the coma and check my brain function first. I was in a coma for about a day and a half to two days before I woke up. Apparently, I didn't need CABG. I had several complications, but broken ribs wasn't one of them. I wonder if it was the machine's consistent compressions or my natural joint flexibility (AKA double-jointed). However, I did have problems with my lungs: pulmonary edema, partial collapse, and intubation pneumonia with bloody cough. I had other issues too: DVT in one leg; acute kidney injury; ischemic colitis, anemia, and my chart said Hypoxic Ischemic Encephalopathy. I'm not sure how severe HIE is, because my mental ability mostly came back with only minor aphasia, and I wonder if some of my remaining brain fog is due to anemia and medicine side-effects. I also had really bad sciatica that may have been caused by immobility during the coma, which lasted for 6 weeks and made walking, standing, sitting, and laying down extremely painful. I know DVT sounds minor, but they gave me a blood thinner for it. The blood thinner caused the Ischemic colitis lesion to start bleeding. That resulted in my H&H crashing which required transfusions. This presented a dilemma: stop the blood thinner and risk the clot breaking and going to my lungs and causing a pulmonary embolism, or keep using the blood thinner and risk further anemia and intestinal injury. Luckily, there was a third option: they installed an IVC Filter to catch any clots and then they were able to stop the blood thinner and the bleeding resolved within a week. All in all, I spent a month in 3 hospitals: ER; CCU (Critical Care Unit) and cardiac floor at an acute care hospital; rehab hospital; back to the acute care hospital where I was in IMC (Intermediate Care) then general wing; back to rehab hospital. Now, we get to the question of the day: "Would I want to do that over again?" Um... due to my current age (50) and resiliency, I suspect I'd survive again. But I hesitate to say for sure. I have no family of my own, no wife/gf, and I'm currently dealing with PTSD due to the event and unemployment. I was thankful after waking up. However, my convalescence was interrupted by the pandemic, and all the political arguing about that and the election. It all makes me wonder whether this is a world I want to come back to. Question: Do you think the use of a LUCAS or similar device might be helpful in a hospital setting or in other settings? When I mentioned it to some of the nurses treating me they had never heard of it and wanted to look into it.

Useful video thank you. Being Mortal by Atul Gawande made me think about this earlier. Discuss resuscitation and end of life care with family and document your wishes.

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