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."

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.

>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.

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.

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.

> 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.

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.

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.

> 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.

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.

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/102k...

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.

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".

Sounds like he administered a precordial thump.

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.

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.

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.

> (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.

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?

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.

> 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?

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.

False positive paradox.

> 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.

I think AEDs can also pace these days if it's brady (but not asystole)

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.

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.

I would recommend reading the article.

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/

The article links a source and says "In real life, people similarly believe that survival after CPR is over 75%"

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.)

I guess we’re in a state where any reporting is meant to change behaviors?

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.)

This was true in a recent Swiss training as well.

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)

I think the risk that people don't even start if they worry about survival rates is higher.

> it won't make things worse

Maybe you should read the article.

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.

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.

What did the dead people report as their most desirable outcome?

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.

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.

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.

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.

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.

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.