CPR - pro or con

[lwt16]

I have multiple real world saves. None are from CPR. Chest seals, wound packing hemostatic gauze, and Narcan are the majority of mine.

I even have one Heimlich save.

Nonetheless, CPR is a valuable tool for me. I keep my certification up to date and carry trauma gear pretty much everywhere. Stop the Bleed is something I wish more people would take and I teach several classes each year, typically free of charge.

I did have one CPR attempt on a gunshot victim where I took over for a bystander who was performing ineffective chest compressions. When paramedics arrived, they took over and later told me that my compressions were correctly administered.

It’s rewarding to save people. After your first one, you want to keep gear on you and keep certs up.

[Joe S]

Last I heard, survival rates was something like 7-8% out of hospital, with a good bump into the teens if you have EMS within 2-4 minutes, and 20 something in hospital. Not great, but as already pointed out, better than nothing.

I have a family member who executed a save her only real time ever doing it on a male teen. She told me about it when I was young, and then I had the audacity to ask the instructor at my first certification why they don't tell people that you're pretty likely to break ribs. I was shushed. I just figured that it was better for folks to know, so they didn't think they did something wrong and stop.

I know one guy who they estimate was stopped about 11 minutes. It took a couple years for him to cognitively get back (30s male with a history of drug usage), but they credit a luckily fast EMS response (sub 2 minutes) with the difference.

If I saw the event happen, I would try on any human/dog/cat. Like others have said, any shot is better than no shot.

Reminds me to get a new face shield for the EDC kit. Also, if you keep an eye out, lots of public places have AEDs: hotels, restaurants, public transport stations.

[RoyGBiv]

Recently took a CPR refresher. Instructor said our local response time is 4 to 6 minutes, and made us do CPR for 3 minutes, twice (we had some older folks in the class, instructor didn't want to kill anyone). The dummies we used had indicator lights that gave you feedback on whether you were doing it fast enough and deep enough. Was an excellent reminder of how much effort it takes to do it correctly.

I'm no medical professional, but, I'd do the CPR if it was needed. No reason not to, assuming normal circumstances. I'd feel way worse watching someone die and doing nothing. I'd rather know that someone tried to save my loved one and it just didn't work out, rather than knowing everyone stood by and watched them die.

[GearFondler]

I'd rather know that someone tried to save my loved one and it just didn't work out, rather than knowing everyone stood by and recorded them with their phone as they died.

FIFY

[paherne]

I'm 0-4. Yay! Before Narcan was a thing, I got really pissed when I found a local dope fiend dead on the hood of a car while I was looking for a missing 16 year old girl at a juvenile party. I had no sleep that day and was really upset that he decided to die in my beat. I called for medics, did shake and shout, sternum rub, nada. Finally, I punched him as hard as I could in the center of the chest and he re-animated, opened his eyes and said my name, like he was shocked to see me. He told everyone including fire and medics, that I had saved his life. The save was...temporary, but it's didn't happen in my beat and wasn't my paper.

I'm 2-0 on heimlich choke saving.

Our first use of a TQ in my Department was New Year's Eve where a drunk party host tried to saber a bottle of Dom Perignon and would up mostly removing his hand. I worked in an interesting community.

[Duelist]

With our second child, my wife had some pretty severe complications, and a couple of days postpartum, she crashed out in her hospital room.

Lots of CPR and shots of adrenaline and finally, central lined adrenaline with an IV got her back, but she was resuscitated several times in the process.

When she started waking up in the ICU about 30 hours later, she kept complaining of chest pain, I’d explain it to her, she’d forget and ask again. One time, the male ICU nurse who actually performed most of the chest compressions while the doctors were doing other things to keep her alive was walking by while she was asking again why she was in ICU and why her chest hurt. I waved to him, he waived back, and then I said, “You see that guy?” “The football player dressed like a nurse?” “Yeah, that one. He did chest compressions on you yesterday for over an hour. That’s why your chest hurts.”

They said the amnesia was normal, and she’d need it repeated a bunch of times even after we left the hospital. Years later, she remembers most of what I told her, but not always in the right order.

IIRC, he didn’t break any of her ribs.

The high school I work at has AEDs on the walls, and all staff watch the video about how to use them every year at the start of school. Epilepsy video, too. If I coach, I have head injury and more CPR and first aid training I have to do as well.

[LJP]

Ribs breaking is due to calcification of the cartilage joint them to the breastbone. So it is more commonly encountered in the older population. If it happens, it happens. Probably will if CPR is being performed correctly.

I haven’t read the article, but I am an AHA CPR, ACLS, and PALS instructor and I am responsible for tracking cardiac arrests at my agency and entering them into CARES - Cardiac Arrest Registry to Enhance Survival. We run around 2-3% discharged alive from the hospital.

By far, I think the most valuable use for CPR is in the setting of cardiac arrest secondary to myocardial infarction when we can get the patient to a cath lab and PCI intervention, and asphyxia induced arrest where the hypoventilation and hypoxia can be corrected. Most pediatric arrests fall into this latter category.

Of note to this demographic, cardiac arrest due to penetrating trauma has a higher survival rate than does blunt traumatic arrest. This is assuming rapid replenishment of lost blood volume and a trauma center that can emergently operate to fix the damage.

Bottom line, CPR works if done correctly, assuming a correctable problem caused the arrest. Some people, it’s just their time no matter what we do. But if there is a correctable problem with no CPR, the victim will be brain dead within about 4-6 minutes. Bystander CPR is important. Assuming a cardiac etiology, hands only CPR is a perfectly viable option until trained personnel arrive with appropriate equipment.

In 23 years, I’ve only got two legitimate “code saves.” Both younger with cardiac induced arrests. I’ve also planted a whole hell of a lot of ICU vegetables that languish and die two weeks later, but I don’t feel particularly good about those.

[TGS]

Just to put some things into context:

CPR and AEDs are not a "either/or" thing. All CPR does is keep blood flowing, hopefully oxygenated blood, whereby that oxygen reaches organs. All it does is buy you time to use an AED. CPR on its own does not typically "bring people back".

If you're doing CPR on most adults with no AED arriving quickly, you're kind of just twiddling your thumbs. Children are different, and they can have very respiratory driven responses. For instance, one time we transported an infant who had 40+ arrests during the transport. Usually a tap on the chest and influx of O2 did the trick. That's an extreme example just to make the point, but if you ever wondered why kids get 15:2 instead of 30:2 like adults, that's why.

In my prior job as EMS, we had very few CPR saves. By the time we arrived, most people were already beyond saving, or they were already brought back by the police arriving with an AED prior to our arrival.

Cardiac arrest saves can typically be predicted by 3 things: 1) immediacy of CPR (less than 2 minutes from onset), 2) quality of CPR, and 3) immediacy of AED application. If you can start immediate good quality CPR and have an AED readily accessible, your chances aren't that bad. Losing 1 of those 3 "pillars" disproportionally sways things into the "bad outcomes" category. Need to wait 2 minutes before someone starts CPR, and when it finally starts they do shitty CPR, and you have to wait on police/fire/EMS to show up with an AED? Yeah, those aren't good odds you're looking at.

@MGW There are no affordable AEDs. You can usually find factory refurbished ones for under a thousand, which is well more than what most people (or even businesses) are willing to shell out. We had a lot of AEDs at my EMS agency (moreso than most, by chance), so we used to let our employees sign them out if they were having some sort of weekend event or going to a cabin, that sort of thing. Also keep in mind the upkeep of an AED...leave it in the car all the time where the car goes above 120* internally, and you're looking at about a year of life on the battery. Batteries and pads cost a few hundred to replace, usually.

[TGS]

Isn't a layman's CPR, say on the street, a lot different than in a hospital. Don't they have crash carts in hospitals with trained personnel to use them?

My wife has a do-not-resuscitate order on her medical directive. I don't.

End of life CPR vs early and mid-life CPR are two different things. Once I reach a certain level of mental and physical ability, as well as rate of declining health, I will probably have a DNR (like most medical providers I've worked with.

As for the CPR on hospital vs on street, yes and no. There's a lot of shit on that crash cart, and most of it doesn't really do a whole lot and we use it because that's the "standard of care" established by decades of use based on theory and very little in the way of evidence. The defib used may be a fancy Lifepak 15 unit with all sorts of functionality, but the actual part of "zapping" you is exactly the same as some of the public access units used by laymen. The CPR itself is pretty much the same. Immediate high quality CPR with AED use within 2 minutes is what makes the difference.

[DDTSGM]

I have two assisted field saves, both accompanied with one person (me) doing compressions and the other person in one case doing bag valve breathing with oxygen running, and the other case mouth to mouth.

I have three other non-successful solo attempts, but truthfully, those were of the PR CPR category. All of these were before the compression only protocols for single-rescuer.

My sister's ex-partner ran the fitness center at IU-PU in Indianapolis. Several days after they got their first AED they had a middle-aged guy go down while running. Got him back first zap. She was stoked, needless to say.