When the media reports on sensational, titillating 911 calls, damaging misinformation often flourishes. Take the media-famous example of Lorraine Bayless, who became part of a news flurry when a staff member at her senior community refused to give her CPR after she collapsed, even when the 911 dispatcher pressured her to do so.
CPR stands for Cardio Pulmonary Resuscitation. This is a method of trying to restore circulation and breathing for a person who has no pulse or is not breathing. You’ve seen it performed fictionally a million times on TV and in movies. But is it all it’s cracked up to be? Maybe only if you measure in terms of ribs…
Dangers of CPR
The downward force exerted on the chest by CPR can result in fractured ribs, especially in the elderly, whose bones are more fragile. Broken ribs are not only painful; they can also puncture a lung and lead to mechanical ventilation and the need for a chest tube to reinflate the lung. Fractured ribs can also lacerate the liver or spleen.
On television, 75% of the time the victim receiving CPR is successfully revived. The fact is, CPR is almost never successful. Actually, when a victim’s heart is restarted, it is usually the result of using a defibrillator, which electrically shocks the heart into starting again. (Defibrillators are things they rub together and then yell, “CLEAR!”)
CPR Is Less Effective Than You Think
The cold, hard truth is that CPR is less than 5% effective for elderly victims with medical problems.
Television depicts the end result of CPR as ending in death or a full recovery. In reality, many of those who are revived by CPR wind up severely debilitated. A study completed in 2010 (NPR Podcast, “The Bitter End”) found only 8% of those revived by CPR survive a month. Of those 8%, 3% have a good outcome; 3% end in a chronic vegetative state, and 3% are not comatose but not functioning.
This is not to say CPR should be abandoned in dire situations. A drowning victim should promptly receive CPR. When a person has stopped breathing because of low body temperature or another readily reversible condition, the success rate is pretty good.
The Downsides of CPR: A Testimonial
In a recent op-ed at The Bakersfield Californian, physician Jennifer Black provides useful insight into the risks of CPR, and how the general public tends to have an overly-rosy view of this widely-misunderstood procedure–especially as it pertains to the elderly or physically infirm. Here’s an excerpt (emphasis mine):
As a medical student at USC and a physician-in-training at Kern Medical Center, I remember clearly the times I performed CPR. The experience was certainly not what I’d been led to expect during my CPR class. I recall feeling ribs splinter and breastbones break under my hands; I witnessed teeth crack and lips tear as breathing tubes were forced into victim’s throats. Chests were bruised, skin was burned, and lungs collapsed. I was horrified that I had to subject elderly, frail patients to such violence. Very few patients survived the initial effort; those who did were young, and were usually trauma victims, not elderly patients who’d had a stroke or heart attack. All CPR survivors had neurological damage, abdominal bleeding or ruptured spleens. Most of them died in the ICU — the majority within hours, but a few after several agonizing weeks. I did not know at the time that these are the expected complications and results of cardiopulmonary resuscitation.
Studies show that most people’s beliefs about CPR come from television. As a result, the public’s expectations of CPR survival are extremely high: most of us think at least 75 percent survive. In one study, 81 percent of hospitalized patients over age 70 believed their chances of surviving CPR and leaving the hospital to be more than 50 percent. Well, if these patients had been actors on a TV show, they’d have been right: CPR “works” 75 percent of the time on television!
In reality, success is much less frequent: If CPR were performed on every single patient in the average hospital, just 15 in 100 would survive to go home. Worse yet, if CPR is done out in the community (such as in Glenwood Gardens’ dining room) on an elderly patient with several medical problems, the likelihood of the patient surviving the initial effort is 0 percent to –maybe! — 2 percent. …
You can read the full op-ed here.
CPR for Seniors: Not Always the Best Answer
The bottom line: when an elderly person has stopped breathing because of heart problems or pneumonia, especially when other medical problems are present, CPR has a very low success rate and creates complications and tribulations the recipient of the CPR didn’t want.
The family of the woman denied the CPR fully supported the decision of the facility. “It was our beloved mother and grandmother’s wish to die naturally and without any kind of life prolonging intervention,”said the family “We regret that this private and most personal time has been escalated by the media,” the statement said.
The low success rate of CPR may be an example of how a medical myth is perpetuated by the media because it is more appealing than the truth. Unfortunately, sugar-coating the concept of CPR leads to unrealistic expectations.
For more information, see “How Doctors Die—What Doctors Want From End of Life Care”.