Health Column: CPR, do you really want it?
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
CPR is a “good” part of our medical milieu, right? It saves lives, and brings people back from the dead.
A recent study showed that more than 80 percent of hospitalized elderly believed that if they underwent CPR, they had greater than a 50 percent chance of leaving the hospital intact. Over a quarter of those surveyed felt that they had a 90 percent chance of doing so. From where does this optimism spring?
In 1996, researchers at Duke University reviewed 90 episodes of “ER,” “Chicago Hope” and “Rescue 911.” They found 60 episodes featuring CPR. Of those “resuscitated,” 65 percent were kids, teens or young adults; 75 percent survived immediate arrest; and 67 percent were discharged from the hospital. On “Rescue 911,” everyone survived. (That’s the show you want to be on.) The outcomes of CPR on TV are either death or full recovery.
What happens in the real world? Cardiac arrest occurs primarily in the elderly, and 75-95 percent of arrests occur in people with underlying heart disease. A 2012 study showed that when “average elderly” had a cardiac arrest outside the hospital, only two out of a 100 experienced long term quality survival. Six to 15 percent of people who had their cardiac arrest in the hospital survived long term, but the authors do not describe the survivors’ quality of life.
Unlike TV resuscitations where patients either die or go on to live full productive lives, real-life resuscitation patients may experience a third set of outcomes — never getting well. Most resuscitated elderly persons experience bruised and broken ribs and injuries to their hearts and lungs with subsequent infections and chronic pain. The most dreaded outcome from CPR is to experience a lack of supply of oxygen to the brain with resulting loss of intellectual function.
Fortunately, cardiac arrest occurs only rarely in kids and in healthy young adults; and when it does, prompt, effective CPR is often life and brain saving. In my opinion, this is why we should all learn to do CPR.
On the other hand, if you are an “average elderly” and fall down without a pulse on Main Street during the Grand Junction Farmer’s Market on a Thursday night, do you want CPR?
There is no right or wrong answer to the CPR question, but this otherwise healthy “average elderly” 73-year-old man casts a resounding “No!” I fear a vegetative state much more than I fear dying.
Recall that the default in our medical system is to do everything to everyone who has a cardiac arrest unless you direct otherwise. Print off a MOST form (available online, google “MOST”) and take it in to your physician to start the discussion.
Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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