If proper CPR involves compressing the chest so much such that the ribcage might break - doesnt that breakage risks a bone puncturing the heart?
If proper CPR involves compressing the chest so much such that the ribcage might break - doesnt that breakage risks a bone puncturing the heart?
While we’re on the topic of CPR, I want to address the myth that CPR “almost never works”. It’s great at what it does, which is pumping blood through the body enough to keep vital organs supplied with a bare minimum of oxygen so they can survive.
However, there’s usually a reason why the heart has stopped beating and in most cases, CPR can’t reverse that reason. If the patient is in a car crash and has completely bled out, CPR won’t get any blood back into their system. Or if they’re at the end stage of a terminal disease, CPR can’t magically cure the disease.
But in cases where the cause for the cardiac arrest is simple and easily reversed, chances of survival are much higher. For example, if someone is drowning and you get them out of the water within a few minutes of cardiac arrest, CPR is very effective, with the majority of patients surviving. Here’s a study with 113 patients who were resuscitated after drowning and only 8 were confirmed dead. For 20 patients, the outcome was unknown, but even if they all died as well, that’s still a 75% survival rate.
It’s not that CPR doesn’t work, it’s that outcomes after resuscitation usually aren’t great. The study doesn’t disclose ages or neurological outcomes post-rescuscitation so that limits my interpretation but quick rescue and quick CPR is key in those acute, single reason emergencies. That isn’t to say in an emergency situation you shouldn’t try especially since you don’t know that person’s wishes. There are good outcomes but usually for underlying healthy people who had one thing go wrong. Think the athlete who’s heart stops on the field for some reason.
I’ve admitted at least a thousand people into a hospital through the ER and I tell everyone that it’s not like on TV. If you’re older, sick, multiple chronic diseases, don’t take care of yourself, etc. the chances of any kind of quality of life after CPR is limited. Death is terrifying and I understand them wanting to try but it’s just not realistic a lot of the time. We need better deaths in the US and more in-depth end-of-life conversations with our patients. That should be starting in the PCP’s office. Trying to discuss that with a patient in the ER who’s already scared isn’t ideal. I’ve seen patients with do not resuscitate/do not intubate orders on file change their mind when they’re suffocating and panicking then once they’re more stable immediately change their mind back.