Any fan of TV medical dramas knows the drill. A patient in the emergency room goes into cardiac arrest, and the resuscitation team springs into action. The compressor begins pumping on the patient’s chest, the airway manager initiates intubation, someone else readies the defibrillators, yells “clear,” and an electric shock jolts the patient.
Tensions build. The drug manager gives a dose of epinephrine. The team leader shouts directions. And because it’s primetime television, a family member cries in the background.
Then, suddenly, they have a pulse. Cardiac activity returns. The patient is saved, and by the end of the episode, they are thanking the medical team and walking out the front door.
In real life, cardiopulmonary resuscitation (CPR) seldom works, yet most people believe it is effective. Researchers are finding that failed attempts can negatively impact medical care providers and cause mortal distress.
Why So Few People Survive CPR
On TV, CPR saves lives, and studies have found that most characters who undergo CPR survive their ordeal. A 2015 study in Resuscitation examined 91 episodes of the medical dramas House and Grey’s Anatomy. Someone performed CPR in half of the episodes, and about 70 percent of the characters survived the resuscitation attempt. Of those who survived, only 15 percent died in the aftermath. The rest were discharged from the hospital.
Many people expect CPR to be as effective and lifesaving as it is seen on TV. A study of surrogate decision makers for ICU patients found that 72 percent of respondents believed that CPR had a success rate greater than 75 percent. In reality, people who undergo CPR outside of a hospital setting survive only 10 percent of the time. Within a hospital setting, CPR survival rates are only a bit higher — about 17 percent. CPR is frequently unsuccessful because most people are “asystole” (or “flat lining”) when they have a cardiac event. They do not have electrical cardiac activity and can’t respond to an electric shock.
“Sadly, less than 25 percent of the patients present with a shockable rhythm, and this number is declining,” says Patrick Druwé, a physician and a researcher with the department of intensive care medicine at Ghent University Hospital in Belgium.
The number of people with a shockable rhythm is declining at the same time CPR has become standard procedure, even among elderly patients in nursing homes. In some countries, like Japan, EMTs are legally prohibited from stopping CPR on anyone who has a cardiac arrest outside of a hospital setting.
“When CPR was introduced in medicine in the sixties, the intention was to treat clearly reversible causes of cardiac arrest, such as a myocardial infarction,” Druwé says. “Nowadays, CPR has become a sort of ritual performed by default without taking into account the probability of a good outcome.”
Read More: Before Modern CPR, There Were Tobacco-Smoke Enemas
Coping with CPR Consequences
Poor outcomes are not only limited to death. People who survive CPR suffer physical injuries. More than 70 percent of people who receive CPR experience rib fractures, with an average of 7.6 broken ribs.
People who survive can also suffer neurological issues because their brains were deprived of oxygen. Post-cardiac brain injury is the primary cause of death or disability after resuscitation.
Resuscitation survival rates have remained “static” worldwide, Druwé says. Yet, there has been an increase in resuscitation events, particularly in nursing homes. In Denmark, for example, CPR rates in nursing homes were at 3.5 percent in 2002. By 2014, CPR usage had quadrupled to 16.5 percent. Similarly, in Japan, CPR rates in nursing homes jumped from 12 to 20 percent in a five-year time span.
Performing CPR on an elderly nursing home patient or a patient without a shockable rhythm can be what some clinicians consider an “inappropriate attempt” because it is unlikely the patient will survive the resuscitation.
Inappropriate attempts can be both problematic for the patient and their medical care team.
CPR Can Lead to Moral Distress
In a 2021 study in Resuscitation, Druwé and his research partners set out to understand how clinicians felt about futile resuscitation attempts. They surveyed about 5,100 emergency room physicians, nurses, and EMTS in 24 countries, including the U.S., to determine whether failed attempts caused moral distress. The study found that two-thirds of clinicians had wondered whether a resuscitation event they had participated in was appropriate, and 50 percent experienced moral distress.
Part of this moral distress came from feeling the attempt was futile or questioning whether the patient even wanted extreme life-saving measures.
Many clinicians assume a patient would want CPR, but Druwé says only a few patients indicate they want CPR no matter the circumstance. And given that few nursing home residents survive CPR, the futile attempt can make a clinician feel as though they’ve gone against what was best for the patient.
“As such, performing CPR with almost no chance of survival with good neurological outcome can be seen as dehumanization since it violates the dignity of the patient and goes against medical ethical principles such as non-maleficence,” Druwé says.
Given the damage that failed CPR can cause both patients and providers, Druwé says more emphasis should be placed on advanced directives so clinicians know how to proceed during a cardiac event.
Druwé says health organizations also need to move away from CPR as the default and instead consider it a conditional therapy used when the patient is likely to survive and live without severe post-resuscitation injuries.
“Professionals must weigh the chance of a future life of acceptable quality, and to what extent the patient will be robbed of a dignified death if CPR is unsuccessful,” he says.
Read More: How a Parisian Death Mask Became the Face of CPR Dolls Everywhere
Article Sources
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Emilie Lucchesi has written for some of the country’s largest newspapers, including The New York Times, Chicago Tribune and Los Angeles Times. She holds a bachelor’s degree in journalism from the University of Missouri and an MA from DePaul University. She also holds a Ph.D. in communication from the University of Illinois-Chicago with an emphasis on media framing, message construction and stigma communication. Emilie has authored three nonfiction books. Her third, A Light in the Dark: Surviving More Than Ted Bundy, releases October 3, 2023, from Chicago Review Press and is co-authored with survivor Kathy Kleiner Rubin.
