8 ms·
When Not To Quit: Man Revived After 96 Minutes
- raleec 15y agoMy first thought is how many people were abandoned because of a reliance on the incomplete picture that the old tech bundle provided.
- relix 15y agoI like to believe this would be less than 1%. Medicine is science, and I hope while designing modern CPR guidelines they did tests to see if pursuing CPR even while all signs suggest death, for long periods of time, would revive more people. Then they probably had to make a key decision between keeping an emergency team busy for 90 minutes for every case where death was probable, just in case there's that less-than-1% chance of revival, or dismissing the team and freeing the resources for patients who have a higher probability of survival, and increasing the probability of survival of those due to faster response times.
- rokhayakebe 15y agoThen they probably had...increasing the probability of survival of those due to faster response times. This is the problem; today everything is a cost/benefit analysis.
- cturner 15y agoI'd say the opposite. We spend vast amounts of money prolonging the life of people who we know in advance are extremely unlikely to generate quantifiable benefit. How do you suppport what you've said?
- rokhayakebe 15y agoI would not want to do business with you or any business associated with your line of thinking.
- anigbrowl 15y agoI see where you're coming from, but what if there is someone else who also needs emergency medical care and has a higher chance of survival? End-of-life care is among the most expensive kinds of medical treatment because often doctors are staving off the inevitable, and that sucks up resources that could be used to treat other people. This seems like a very grim economic calculus, but following a disaster or disease epidemic doctors must make such decisions many times a day, sometimes with only minutes to evaluate patients. Likewise, those who run hospitals (especially public hospitals) have to balance the probability of a successful outcome against the cost of leaving other patients untreated.
- Produce 15y agoIt's not something that can be quantified, though. The problem is that meaning is an entirely subjective phenomenon, so when we talk about trying to save people who are more likely to live, we make the assumption that long life is the correct metric to use. More than that, we assume that there is a correct metric to use in the first place. As a concrete counter-point, what if the person saved will have a terrible life to look forward to? What if it's an abused wife or a (unknown to the doctors) drug addict? What if the person with the lower chance of survival is a parent or Mother Therasa? What if the person with the better survival rate doesn't want to live and will commit suicide shortly? The problem with applying linear mathematics to human issues is that it's a gross oversimplification of a complex problem. Couple that with the relative weight of values (i.e. every person placing a different value on life) and it's clear that rather than being a more objective measure, it is in fact firmly grounded in subjectivity. I think that the objective illusion only serves to calm the conscience. A more objective and fair way of doing this, which also calms the conscience, would be to flip a coin. The other issue is that the line of thinking you have described is the same one used to justify horrendous actions. Sacrificing someone who is seemingly less deserving of effort (again, by our completely subjective criteria) for someone more deserving is the logic used to justify locking people up in prisons, burning witches, gassing Jews, it's all the same - those "less deserving" are sacrificed for those who are "more deserving". And all that with a subjective metric. I think that the root cause of this irrationality is that even the most rational people tend to miss the fact that perfecting one's logic is not enough. After that point, assumptions are everything. Logic is merely a tool for transforming one set of assumptions into another. If you use shit as the input, you'll get an equivalent output.
- rhygar 15y agoOkay rationalist, what if you were sick and someone important deemed that you were "extremely unlikely to generate quantifiable benefit"?
- biot 15y agoYou're reading it wrong. Here's an annotated version of what you replied to: I'd say the opposite [everything is NOT a cost/benefit analysis]. [As evidence of this,] We spend vast amounts of money prolonging the life of people who we know in advance are extremely unlikely to generate quantifiable benefit. How do you suppport what you've said [that everything is a cost/benefit analysis]? [The evidence shows your position to be incorrect, therefore my position that life is more valuable than cost/benefits indicate is true.]
- arbitrarywords 15y agoWell one perspective from the sick persons point of view, "The entire resources of the universe should be spent on keeping me alive". If you decide that there is something wrong with this, you need a strategy to allocate the resources. Then you've got a cost/benefit analysis.
- xibernetik 15y agoHow about if you were sick, but there was a serial killer who had a 98% of dying that, due to this sort of argument, was utilizing resources that would increase your chance of survival from 10% to 95%? This argument fails to show that when it comes down to it, there's more than one person and their associated who get affected by the decision to invest those resources. The benefits to one person come at the expense of another in current healthcare situations.
- blake8086 15y agoShould we ignore cost?
- jhamburger 15y agoGiven those numbers, you'd have a statistical expectation of one life saved for every 150 hours spent. Say $100/hr for salaries+bennies for two parametics, 15K per life saved. I think it's worth it.
- chc 15y agoBut what's the expectation of lives lost due to late emergency crews?
- ohashi 15y agoI wonder how overburned most areas are? I had a friend who was an EMT and said they really liked being called (didn't get the impression they were that busy) because it was far better to be safe than sorry and people were often too hesitant about calling for emergency services.
- JshWright 15y ago$100/hr for salary and benefits? Maybe a half that...
- bh42222 15y agoI like to believe this would be less than 1%. But unfortunately medical errors kill a lot of people: http://www.bbraunusa.com/index-A3866CA8D0B759A1E395A615A2C006AD.html http://www.bbraunusa.com/index-A3866CA8D0B759A1E395A615A2C00...
- bahman2000 15y agoMedicine is science and as such is always evolving. I recently got certified in CPR and defibrillator use. Turns out that CPR guidelines keep changing as scientific research advances our knowledge of what is actually going on. One of the reasons why a first responder should keep getting re-certified every year or so.
- pointernil 15y ago.) Well, yes the new method is better than the prev. tech available, still it is as well only providing an estimate of the true situation... so, not all of the prev. abandoned ppl had a 100% chance to recover as in the described case. .) Yes, it is fascinating to see how the emergency-medicine tech evolves over time... I mean, keeping a man "alive" for that long outside of a situation room, wow! .) Plus: as always, the ppl actually handling those emergencies, deciding what to do on site. "Life over Death" with a clear head... wow^2
- gaius 15y agoWell, I just refreshed my EFR cert, and can tell you that the official statistic is that only 5% of those requiring CPR survive, and that's what all the assumptions are based on.
- yarone 15y agoIt seems that his heart was beating, although irregularly to a degree that they couldn't detect a pulse. Is the article saying that estimating the CO2 output via this new method is a more modern / sensitive way of detecting a pulse?
- pygy_ 15y agoNo, it detects the release of CO_2 from the blood to the pulmonary alveoli. Presence of CO_2 in the alveoli signs the presence of a blood flow, regardless of the nature of the pump (heart vs CPR). If the blood flows, the organs (including the brain, which is the most sensitive to oxygen deprivation) are properly fed and viable (assuming CPR started soon enough).
- sp332 15y agoWell, the heart still has to be in more-or-less the right "shape", right? If the valves are messed up, blood won't circulate through the lungs and back to the organs properly. http://en.wikipedia.org/wiki/File:Heart_diagram_blood_flow_en.svg http://en.wikipedia.org/wiki/File:Heart_diagram_blood_flow_e...
- pygy_ 15y agoIndeed, the valves must be in working order, and there must be enough blood in the vessels to close the circuit and prime the pump. I don't know if it was confirmed, but while I was a student, there were strong suspicions that blood in the whole thorax (pulmonary circulation), not only in the heart, contributed to the assisted flow. Another fun fact: CPR is more efficient if you use a plunger to perform the chest compressions, because you can push and pull it, thus not only pumping blood out of the heart (through the arteries), but also actively sucking it back in (from the veins). As a consequence, at the end of a cycle, there is more blood in the chest to be pumped out on the next one. See http://www.ncbi.nlm.nih.gov/pubmed/21251705 http://www.ncbi.nlm.nih.gov/pubmed/21251705 for the details.
- derwildemomo 15y agothe most common phenomena that leads to that kind of heart activity without any actual pumping result is a ventricular fibrillation, which looks like this: http://www.ecglibrary.com/ecgs/VFNORWCH.gif http://www.ecglibrary.com/ecgs/VFNORWCH.gif, compared to a regular rhythm looking like http://www.grundkurs-ekg.de/definition/ekg1_neu.jpg http://www.grundkurs-ekg.de/definition/ekg1_neu.jpg. This is ( likely ) the underlying problem. What's described here is the fact that the medical personel was able to determine whether their actions ( CPR ) where effective enough to maintain blood circulation. there are, of course other metrics, like o2-saturation levels etc, but this one seems to be especially suitable. One note aside, it's not uncommon for a resuscitation to go on for 1 or even 2 hours, it depends on the circumstances, the patient, the medical situation and most importantly, the timespan that elapsed before cpr was first administered, which was obviously quite fast in this example.
- csomar 15y agoThere is an important thing missing: In order to prove that someone is dead, you must do electroencephalography. This will detect the brain electric charges. Normally, since the patient isn't dead, there will be brain pulses, which will prove he is alive.
- carbocation 15y agoIn which country is it required that a physician perform an EEG prior to declaring death?
- csomar 15y agoI don't know. I'm a medical student in Tunisia. Here, in order to claim that a patient is dead you need to show its' EEG graph. Well, what's happening is something else.
- mikaelgramont 15y agoAn EEG is probably necessary for official reasons, before a "certificate of death" can be issued. But there is a point where the emergency rescuers have to give up, and it probably takes hours before the EEG can be done.
- sp332 15y agoMaybe when the person is already on life support, and you're trying to make a decision about whether the person is "dead" even if most of their organs are alive.
- typicalrunt 15y agoThen what about the wave of death [1] that happens to people? The body can still release pent up energy well after brain death, but it doesn't necessarily mean the person can be brought back to life. [1] http://news.discovery.com/human/near-death-brain.html http://news.discovery.com/human/near-death-brain.html
- 15y ago
- Pyrodogg 15y agoI know that this article is mostly about the medical tech related to this case but I still get a warm fuzzy feeling knowing this happened in my hometown; that it was a crew of volunteer firemen and others that kept the vital CPR going for 96 minutes. I hope the new technology makes it into the hands of EMTs quickly so that more lives can be saved.
- Alex3917 15y agoEvery time I get my VO2 max taken I feel like I'm dying anyway, so this is only a fitting use of the technology.
- thedjpetersen 15y agoI don't know if anyone else noticed this but when I see '==' I think comparison not assignment.
- takeoutweight 15y agoIt really should be logical implication '⇒', shouldn't it.
- raleec 15y agoThis. I'm usually pretty pedantic about this sort of thing, but don't submit very often, and wasn't aware of the 80 char limit. Forced to pare a more descriptive headline and get back to work, I made a mistake. It looks as though it's been replaced with the actual headline now anyway, though I don't think that highlights the most interesting part of the article.
- cmontgomeryb 15y agoI think that was the intention: (tech == man revived) returns true :)
- celoyd 15y agoI don’t think it does. If it did, then the LHS and RHS would be functionally identical, or nearly so. But they aren’t, because you can’t rewrite “New use of existing technology” to “man revived after 96 minutes w/out a pulse” in many contexts, or vice-versa, without a change in meaning. English uses “is” for simple identity, but not as often as it uses it for other things.* Indiscriminately replacing “is” with “=” or “==” is usually only going to confuse any math or programming person trying to take it seriously. And if you don’t mean it to be taken seriously, using “==” for an equally long and much more ordinary word is just silly. * For example, copula: http://en.wikipedia.org/wiki/Copula_(linguistics) http://en.wikipedia.org/wiki/Copula_(linguistics) . This is the form of “is” in “Denver is south of here”. Clearly Denver is not equal to to predicate of relative southernness, or I could say “San Diego is Denver”.
- JshWright 15y agoCapnography is actually required for all intubated patients in many areas (and intubation is a standard step in the management of pre-hospital cardiac arrest patients). This is because (properly interpreted) capnography is one of the most definite ways to verify that the ET tube is headed for the lungs, not the stomach. Given the increasing prevalence of capnography use in the field, I expect the next few years will see several studies into how it could be used to improve patient outcomes.
- sidwyn 15y agoNon-mobile version here: http://www.npr.org/2011/08/22/139670971/when-not-to-quit-man-revived-after-96-minutes http://www.npr.org/2011/08/22/139670971/when-not-to-quit-man...
- mv 15y agough. This is exactly what drives up the cost of medicine. People hear crap like this, and then come in demanding that 'everything be done' for their 95 yo grandmother in a coma in the ICU. Sadly technology can keep this type of person 'alive' for a very long time. Expensive, wasteful, selfish. Medicine needs to send truthful messages about what can and can't be done.
- JoshTriplett 15y agoSays someone who is almost certainly not 95 yet. Expensive? Probably. "Wasteful"? "Selfish"? Not your call, thankfully.
- mv 15y agoYou misunderstand, it isn't selfish to want it for yourself, but it is selfish to keep someone else alive in a vegetative state. It is so easy to choose 'life' as the correct and right thing when in fact 'death' is the natural and moral thing. Society needs to think about their end of life plans. If your plan is to be fed through IVs, have a foley, breath through a machine, have a butt tube, and foley catheter in for the last 10 years of your life be my guest. Just please don't use any of my tax dollars for that! The sad thing is most people don't chose this for themselves, instead they have a stroke or suffer another handicap and while they are unable to make decisions (probably unable forever) the family chants 'do everything you can'! Medicine can do a lot, but mostly at the end of life it just prolongs misery. I routinely ask patients their 'code status' and articles like this give them false hope and false belief. Instead of: "do you want us to do cpr if your heart stops and/or intubate" ... I should be saying, "do you want your last dying moment to have someone beating on your chest breaking all your ribs while another person shoves a tube down your throat as you get pumped full of drugs." You will never forget the first time you push on ribs and feel the crunch, watching the half-dead eyes look up at you as they live their last moments, and wondering if they are feeling their veins burn with drugs being pumped in. Never mind that the article makes it sound like resuscitation efforts are grand. They aren't at all. The statistics are dismal. Oh ACLS drugs? Yea, they don't really work to well... even as far back as 1998.. there are newer studies showing that ACLS training is helpful, but the actual drugs make little to no difference. http://www.sciencedirect.com/science/article/pii/S0196064498700319 http://www.sciencedirect.com/science/article/pii/S0196064498... Less than 18% (!) requiring resuscitation survive to discharge. http://www.nejm.org/doi/full/10.1056/NEJMoa0810245 http://www.nejm.org/doi/full/10.1056/NEJMoa0810245 http://www.sciencedirect.com/science/article/pii/S0300957203002156 http://www.sciencedirect.com/science/article/pii/S0300957203...
- troymc 15y agoDoes this mean that the "Flatline" (See http://tvtropes.org/pmwiki/pmwiki.php/Main/Flatline http://tvtropes.org/pmwiki/pmwiki.php/Main/Flatline ) will have to be relegated to TV and movie history?
- d2 15y agoMy favorite paragraph: The nurse "called the emergency room doctor, who told him that I was dead and that they should walk away," says Snitzer. "And he hung up and he said to the rest of the people in the room, 'Is anyone else here uncomfortable with walking away from this?' And they all said yes. And it was at that point that he called Dr. White."
- stretchwithme 15y agoThat is a fantastic use of technology. This is interesting: "Now, during good CPR, this is probably going to be around 25 — if you keep this up in that 25 range, then there's circulation still going on. ... That's where you're going to get a positive outcome,". So essentially, if CPR is working, you don't need to die even if your heart and lungs aren't working on their own. CPR is doing their work well enough, for the moment anyway. If they keep at it all the way to the hospital, you may survive. Of course, if you'd seen Lindsey brought back in Abyss, you'd already know this is possible :-)
- maeon3 15y agoImagine all the people that could have been saved if only the doctors knew what action to take. I imagine people stuck in a coma, listening to everything going on around them saying: "keep doing what you were doing, it is working", and instead watching them decide to give up.