One of two interesting pieces I spotted in The Telegraph today, each of which is getting its own post. This one is Max Pemberton’s Why it’s often better not to resuscitate – something that any of us who have been trained in First Aid probably don’t consider. Part of Max’s article is aimed at medical professionals, and it makes grim reading:
I remember, as a junior working nights, running to cardiac arrest calls, only to be met with a pitying look from nurses as they explained that the call was for an elderly, terminally ill patient without a “do not resuscitate” form. I was therefore obliged to attempt to resuscitate, wincing as I cracked the patient’s ribs with each compression, knowing that I was subjecting a dying person to something futile, painful and cruel. If they had any sentience left, their last moments would be traumatic and brutal.
Aside from the unedited reality of the actual act of CPR, there’s the other issue of the authority and training of the professional (yes, I understand he was “just” a junior doctor here, but still…) being removed from them by the bureaucracy of the system. No thinking for yourself here. No consideration of the best decision for the patient – you will attempt resuscitation and perhaps allow this person to suffer for a while longer.
The second part of the article is the fascinating dichotomy between TV drama and real life, and the effects thereof.
I know, right? Hoodathunkit?
The British Medical Association (BMA) estimates that in TV dramas three-quarters of people survive as a result of CPR (cardio-pulmonary resuscitation). In reality, of those who go into cardiac arrest outside of a medical environment, the figure is less than two per cent. In hospitals, about half survive the initial event, but only 20 per cent live to be discharged. For those who are frail or seriously ill, positive outcomes are vanishingly small.
This skewed portrayal of successful CPR on television has the effect of erroneously raising the public’s expectations –particularly traumatic for the friends and family of those who go into cardiac arrest. And many of those who do survive CPR are left with debilitating conditions such as brain damage, also rarely shown in TV dramas.
Of course, it should be remembered that anyone who has a cardiac arrest in a medical environment (or “hospital”, as we laypersons call them) was most likely within that medical environment because they were already unwell. But the shock for me wasn’t the difference between the figures depending on where you have your cardiac arrest (although, having seen this, I wouldn’t really suggest having one anywhere), but that “less than 2%” chance of survival outside of a medical environment.
Less than 2%? Not. Good. Odds.
Cardiac Arrestees in Seattle (home of ‘really medically accurate hospital drama’, Grey’s Anatomy), have a chance of survival, simply because their EMS service has identified cardiac arrest as their number one priority, and work specifically hone their services to saving these patients. Part of this approach is the widespread availability and publicising of training for citizens, with the result that:
King County has the nation’s highest rate of witnesses of cardiac arrest performing CPR… When done at the scene, CPR doubles the victim’s likelihood of survival.
55% of individuals who suffered a cardiac arrest in 2012 in King County survived the event, and:
…85 percent of those maintained good neurological functioning. That survival rate has doubled in the county since 2002 and is significantly higher than the nation’s average of 8 percent.
So don’t let this dissuade you from trying to help.
The CPR vs DNR decision is for the doctors and their petty managers to sort out. For the man on the street (literally, he just collapsed and he is now flat on the actual surface of the street), no matter how small the chances of success, anything is better than nothing. If you have the training (and you really should have the training – it’s quick, easy and generally free to get), you should always have a go if you end up as first responder in an emergency case.
