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 £1000 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.

You can now get single use defibrillators that are cheaper but they have a limited life span.

All defibs do. The battery and pads need replaced every few years.

I think they work best in combination. The CPR can keep your brain alive long enough for the defib to arrive.

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.

Also, there are shockable and non-shockable heart rhythms. A defibrillator is not a catch-all solution.

(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.

>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...

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.

+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.

If defibrillators are that effective, making them accessible should be a bigger deal. Why are they so expensive after all this time?

Maybe there could be an Emergency App included in all phones with offline first aid info, a deadman switch that calls 911 if you let go of the button, and maps of the building you're in with are and fire escape plans, if they published one.

Lots of businesses that could afford one still don't have them, why isn't there any legal requirement for million dollar profit places to have them?

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.

> 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.

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.

This distinction was my take away from the article.

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.

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.

> 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.

>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.

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]?"

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.

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.

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.

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.

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.

not quite - if you stopped breathing, but your heart is working, you have an excellent chance of recovery if someone keeps air going in and out - that’s often the case for children and young people . If your heart stops after trauma, it’s mostly due to something cpr doesn’t address, like severe blood loss, once your heart stops from blood loss, usually your brain is irreversibly damaged in a very short time. The other key group that benefits is people with a “heart that’s too good to die” - meaning a strong heart in a shockable rhythm, in which case cpr may keep your brain alive long enough for someone with a defibrillator to fix the rhythm problem. that’s about 20% of all deaths: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020177/

So probably the optimal message is 1) learn how to do cpr and use it if you ever see someone collapse, but 2) if a doctor suggests that cpr would not be in your or your loved ones best interests, they’re usually right.

I do agree with the author about asking people if they want a “natural death” instead of asking if they want “cpr” or “resuscitation”

For 1), if by "traumatic" you mean "bodily trauma" then it's actually the opposite. If your heart stops due to bodily trauma, it does so as a result of other problems like a lack of blood volume, or something physically impairing your body's ability to oxygenate, none of which are improved by CPR.

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.

> I was dead on the street at 15

Big difference between 15 and 85 or 95.

CPR successfully resuscitating a traumatic arrest is highly unusual. Consider yourself anomalously lucky.

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).

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.

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.

CPR saved my dad's life as well

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.

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.

> The value of CPR by is rarely derived from successful resuscitation.

This isn't even what I'm talking about, but it also isn't strictly true either. End result does matter. These influence how we write the guidelines about the chain of survival.

> The purpose of this procedure is to get some, however small, bit of oxygen into the patient to prevent brain damage.

CPR is indicated for cardiovascular and pulmonary arrest. It is not uncommon at all that bystander CPR is provided to those experiencing neither. Senior citizens that come in with the EMT reporting bystander CPR though noted to be fully awake and alert, no EKG changes and a non-existent troponin. The chances that they had a true arrest are vaningishly small.

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!

I took a rescue diver certification course and after they went through lots of procedures for how to rescue someone, perform CPR, etc and drilled you in varying ways about it, at the exact end of the course they level with you and say the odds of someone actually recovering from these kinds of dive accidents is dismal. Don't beat yourself up if your patient doesn't survive, you tried your best :thumbsup:

I agree these interventions are worth trying but it's definitely important for first responders to be realistic about the success rates so that they aren't haunted by the failures.

CPR shouldn’t work on someone dead from a traumatic injury. For example chest compressions will only hurt someone dead from having their chest crushed against a steering wheel in a car accident. What happened to you is a true miracle and far outside the norm.