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EMT here. CPR rarely works, and sometimes when it does work the result is permanent brain damage so the patient dies the next day anyway. Nevertheless it's wor

EMT here. CPR rarely works, and sometimes when it does work the result is permanent brain damage so the patient dies the next day anyway. Nevertheless it's worth doing on people who are having e.g. a sudden cardiac event because you only do CPR on dead people. Which means as long as they died because of some single-point correctable failure, it doesn't hurt to try CPR because it might succeed and that's better than being dead. OTOH if they died because of multisystem organ failure or distributed catastrophic blunt-force trauma, CPR will never bring them back. Medical professionals know all this, and as the article points out the moral distress of failed CPR is related not to the fact that it so often fails but that it's inappropriate to even start CPR on an 80 year old patient in a nursing home who has dementia.

01HNNWZ0MV43FF 2y ago
The permanent brain damage is the result of the CPR or the result of oxygen being cut off?
- jerlam 2y ago
  Not the OP, but it's the latter. The entire purpose of CPR is to get some oxygenated blood through the brain so that there is someone worth saving when help arrives. CPR is often not performed in time, or well enough, and is likely not a 100% direct replacement for normal breathing; so permanent brain damage is likely even if the person is revived. I don't know if the de-emphasis on rescue breathing makes a difference.
  - bookofjoe 2y ago
    Retired neurosurgical anesthesiologist here. The de-emphasis on rescue breathing was the biggest advance in CPR since it began. No non-anesthesiologist can do this effectively (even in Advanced Life Support recertification classes, anesthesiologists — including me — struggled to achieve adequate air exchange with rescue breathing on a mannequin, which is far easier than on an unconscious person). Full energy and attention and effort keeping up deep regular chest compressions at witnessed or just-occurred out of hospital cardiac arrest/loss of consciousness events stands the best chance of a good outcome. In-hospital arrests are almost universally fatal.
    - FireBeyond 2y ago
      100%. Critical care paramedic. Even when we arrive on scene, airway management and ventilation is a "distant" priority behind defibrillation and effective compressions. > No non-anesthesiologist can do this effectively (even in Advanced Life Support recertification classes, anesthesiologists — including me — struggled to achieve adequate air exchange with rescue breathing on a mannequin, which is far easier than on an unconscious person). Hah, and I guarantee your mannequins are far nicer than ours - we do have some Sim-Men for our ALS providers, but BLS providers etc. are practicing on "cheap" mannequins that you either need to artificially hyper-rotate the head back to get air exchange into the 'lungs'. The citizen CPR classes I teach (well, to providers, too) - the rough rule of thumb is that "for each minute of arrest, the chance of survival goes down 10%", which roughly correlates with my understanding that our blood is generally sufficiently oxygenated for about 7-8 minutes of compressions. > In-hospital arrests are almost universally fatal. As are out-of-hospital traumatic arrests. Other random facts, comments, etc.: - Start compressions, have someone call 911 (if alone, call and go on speaker, put it down beside you). As soon as you have a defib available, use it, zero delay. - Contrary to TV and the movies, defibrillation is not like jump starting a car. If the battery is dead, so to speak, that doesn't work. The best analogy for tech people is this: the heart is malfunctioning. If your computer is malfunctioning, you'd ultimately hit Ctrl-Alt-Delete, reboot, and see what happens. That's defibrillation - apply sufficient energy to cause the various nodes of the heart (I'm not being precise here, but trying to explain more easily) to 'failsafe' and reboot, and try to bring about an organized electric current to flow through those nodes to get a coordinated muscle contraction that makes up a pulse. - You are generally not breaking ribs. You're separating cartilage from the sternum. This is "not a concern". - Compressions are 1/3 to 1/2 the depth of the chest. If you're not sure, or worried, go deeper (unless it's a little old lady who weighs 80lb, it's pretty difficult to go "too deep"). - If the person is unresponsive, to vigorous stimuli, start CPR. Don't try looking for a pulse. It is difficult to describe to a lay person over the phone where to find the carotids (and do not rely on TV shows to be of any assistance). Contrary to popular belief, doing CPR on someone who actually still has a pulse is -not- a problem. In fact, EMS will continue chest compressions after getting ROSC (return of spontaneous circulation) for a CPR cycle to "support" circulation. - Once you start CPR, don't stop. Yes, it's hard work. We rotate compressors every two minutes because quality declines. But if you're alone, yeah, it's going to suck, but keep going. It takes about a minute and a half of compressions to build up effective blood pressure for perfusion (because you pushing through the chest wall is obviously less effective than the squeeze of the left ventricle), and only about 8 seconds of no CPR to lose that work. -Even when EMS arrives- they'll tell you to continue CPR until we are literally ready to switch in beside you. - In adults - realize that we're not "fixing" anything. ROSC is a good "outcome", especially in the field. But we didn't clear the blood vessels of plaque. The fixes for arrest happen in the cath lab or theater. It is entirely possible (and really, the default) that the person will re-arrest while we're packaging or transporting the patient. - In children, there are two major causes of cardiac arrest: 1) congenital heart defect (known or unknown), or 2) FBAO (foreign body airway obstruction) and similar things, like near-drowning events. For number 2, the merciful aspect is that if the root problem is solved, re-arrest is unlikely. If something is blocking the airway, and is subsequently vomited up, or dislodged by compressions, the problem "goes away". - Work to the side of your patient. Don't lean over their face or head. That's a good way to get sometimes fairly forceful bloody vomit in your direction. Expect potential incontinence of bladder or even bowel (to quote a gruff instructor I had, "they can't control the function of their heart, what makes you think the muscle tone of the bladder is a higher priority for the body?"). Also, on a personal note, I am very appreciative to the anesthesiologists I know who have been instrumental in my initial and ongoing education for your assistance and teachings as we learn and practiced tube placement in theater.
sidewndr46 2y ago
Even the CPR class I had to take touched on this. You're unlikely to do much other than break some ribs on an adult, which is not going to be fatal. You just do CPR because what else are you going to do. The same class also did cover that AEDs are basically everywhere and pretty much anyone can use them as long as you remain calm. It also covered that mouth-to-mouth CPR on a 7 year old is a good idea because they tend to do weird stuff like choke on some toy or their food. 47 year olds rarely pass out from choking on food.

01HNNWZ0MV43FF 2y ago

The permanent brain damage is the result of the CPR or the result of oxygen being cut off?

jerlam 2y ago
Not the OP, but it's the latter. The entire purpose of CPR is to get some oxygenated blood through the brain so that there is someone worth saving when help arrives. CPR is often not performed in time, or well enough, and is likely not a 100% direct replacement for normal breathing; so permanent brain damage is likely even if the person is revived. I don't know if the de-emphasis on rescue breathing makes a difference.
- bookofjoe 2y ago
  Retired neurosurgical anesthesiologist here. The de-emphasis on rescue breathing was the biggest advance in CPR since it began. No non-anesthesiologist can do this effectively (even in Advanced Life Support recertification classes, anesthesiologists — including me — struggled to achieve adequate air exchange with rescue breathing on a mannequin, which is far easier than on an unconscious person). Full energy and attention and effort keeping up deep regular chest compressions at witnessed or just-occurred out of hospital cardiac arrest/loss of consciousness events stands the best chance of a good outcome. In-hospital arrests are almost universally fatal.
  - FireBeyond 2y ago
    100%. Critical care paramedic. Even when we arrive on scene, airway management and ventilation is a "distant" priority behind defibrillation and effective compressions. > No non-anesthesiologist can do this effectively (even in Advanced Life Support recertification classes, anesthesiologists — including me — struggled to achieve adequate air exchange with rescue breathing on a mannequin, which is far easier than on an unconscious person). Hah, and I guarantee your mannequins are far nicer than ours - we do have some Sim-Men for our ALS providers, but BLS providers etc. are practicing on "cheap" mannequins that you either need to artificially hyper-rotate the head back to get air exchange into the 'lungs'. The citizen CPR classes I teach (well, to providers, too) - the rough rule of thumb is that "for each minute of arrest, the chance of survival goes down 10%", which roughly correlates with my understanding that our blood is generally sufficiently oxygenated for about 7-8 minutes of compressions. > In-hospital arrests are almost universally fatal. As are out-of-hospital traumatic arrests. Other random facts, comments, etc.: - Start compressions, have someone call 911 (if alone, call and go on speaker, put it down beside you). As soon as you have a defib available, use it, zero delay. - Contrary to TV and the movies, defibrillation is not like jump starting a car. If the battery is dead, so to speak, that doesn't work. The best analogy for tech people is this: the heart is malfunctioning. If your computer is malfunctioning, you'd ultimately hit Ctrl-Alt-Delete, reboot, and see what happens. That's defibrillation - apply sufficient energy to cause the various nodes of the heart (I'm not being precise here, but trying to explain more easily) to 'failsafe' and reboot, and try to bring about an organized electric current to flow through those nodes to get a coordinated muscle contraction that makes up a pulse. - You are generally not breaking ribs. You're separating cartilage from the sternum. This is "not a concern". - Compressions are 1/3 to 1/2 the depth of the chest. If you're not sure, or worried, go deeper (unless it's a little old lady who weighs 80lb, it's pretty difficult to go "too deep"). - If the person is unresponsive, to vigorous stimuli, start CPR. Don't try looking for a pulse. It is difficult to describe to a lay person over the phone where to find the carotids (and do not rely on TV shows to be of any assistance). Contrary to popular belief, doing CPR on someone who actually still has a pulse is -not- a problem. In fact, EMS will continue chest compressions after getting ROSC (return of spontaneous circulation) for a CPR cycle to "support" circulation. - Once you start CPR, don't stop. Yes, it's hard work. We rotate compressors every two minutes because quality declines. But if you're alone, yeah, it's going to suck, but keep going. It takes about a minute and a half of compressions to build up effective blood pressure for perfusion (because you pushing through the chest wall is obviously less effective than the squeeze of the left ventricle), and only about 8 seconds of no CPR to lose that work. -Even when EMS arrives- they'll tell you to continue CPR until we are literally ready to switch in beside you. - In adults - realize that we're not "fixing" anything. ROSC is a good "outcome", especially in the field. But we didn't clear the blood vessels of plaque. The fixes for arrest happen in the cath lab or theater. It is entirely possible (and really, the default) that the person will re-arrest while we're packaging or transporting the patient. - In children, there are two major causes of cardiac arrest: 1) congenital heart defect (known or unknown), or 2) FBAO (foreign body airway obstruction) and similar things, like near-drowning events. For number 2, the merciful aspect is that if the root problem is solved, re-arrest is unlikely. If something is blocking the airway, and is subsequently vomited up, or dislodged by compressions, the problem "goes away". - Work to the side of your patient. Don't lean over their face or head. That's a good way to get sometimes fairly forceful bloody vomit in your direction. Expect potential incontinence of bladder or even bowel (to quote a gruff instructor I had, "they can't control the function of their heart, what makes you think the muscle tone of the bladder is a higher priority for the body?"). Also, on a personal note, I am very appreciative to the anesthesiologists I know who have been instrumental in my initial and ongoing education for your assistance and teachings as we learn and practiced tube placement in theater.

sidewndr46 2y ago

Even the CPR class I had to take touched on this. You're unlikely to do much other than break some ribs on an adult, which is not going to be fatal. You just do CPR because what else are you going to do. The same class also did cover that AEDs are basically everywhere and pretty much anyone can use them as long as you remain calm. It also covered that mouth-to-mouth CPR on a 7 year old is a good idea because they tend to do weird stuff like choke on some toy or their food. 47 year olds rarely pass out from choking on food.