This short article tells a compelling story of a life saved because of bystander CPR, and uses a gathering of such survivors and their saviors to encourage others to learn CPR. It makes an emotional pitch for the value of CPR by non-medical personnel, and leaves readers with the clear implication that CPR is an emergency measure with a proven, high success rate, even in the hands of amateurs. And therein is the problem. CPR does save lives, but at a rate many experts acknowledge is astonishingly low, even when performed by EMTs, physicians, and nurses in hospital settings. It’s hard to fault a story that may prompt “civilians” to get potentially life-saving CPR training, but readers would have been much better served to also hear about the substantial downsides to CPR, urgent need for public support of further CPR research, and alternatives to current CPR resuscitation efforts, such as the out-of-hospital use of automated external defibrillators, also known as AEDs. In short, the story offers a false sense of security to those who may suffer — or witness — sudden cardiac arrest, and misses the chance to inform the public about the need for and availability of better life-saving strategies.
As the article itself points out, cardiac arrest that occurs outside of hospitals, is virtually always lethal without medical intervention, and hundreds of thousands die as a result. There’s no question that in some cases, CPR with or without mouth-to-mouth breathing that forces oxygen to the lungs and brain, can restart a stopped heart, but in the more than 50 years since CPR was introduced into medical practice, research has shown that even when this happens, patients very rarely recover fully or at all. When elderly sick individuals experience cardiac arrest, the consequences of “successful” CPR may in fact be devastating and in hospital and hospice settings “DNR” or “do not resuscitate” orders are increasingly requested.
The bottom line is that CPR is not without serious risks beyond failure. And members of the public who may have or plan to have CPR training should understand the limitations of the practice.
The article did not address the cost of obtaining CPR training, nor the cost of providing it. While some training events are free, courses available from the American Red Cross in the Portland, Maine area range from $70 to $110.
Although the article does an estimable job of describing the benefit of bystander CPR on a select few very lucky survivors, it doesn’t talk about the rates of success of various types of CPR or alternatives such as the solo or combined use of AEDs now available in many public spaces. The story says that survival rates “more than double” with the use of bystander CPR, but there’s no context provided with that statistic. What is the rate without CPR and what does it “double” to? The benefits are described primarily in emotional terms; we wanted to see that emotion supplemented with facts.
CPR, when performed by training medical personnel or bystanders, carries risk including broken ribs, internal organ damage and cognitive deficits. These risks are especially high for those with chronic or terminal diseases, or whose arrests already have lasted long enough to cause brain damage. The urge to “help” among bystanders is powerful and praiseworthy; and Good Samaritan laws not only recognize the impulse as humane but also protect those who give aid. But a story so positive about CPR’s benefits has some obligation to alert victims and potential helpers alike of the risks as well as the benefits.
The story altogether ignores data that isn’t anecdotal. A short feature of this sort need not go into great detail about the evidence for success, but this one sadly lacks any context at all about years of research suggesting that the view of CPR seen on TV dramas — in which nearly everyone survives intact — is not an accurate one. (For example, this meta-analysis found that only 4% to 16% of individuals who receive CPR out of the hospital eventually survive to discharge.) In addition, the article references “research” which shows that “CPR knowledge is very low” in high need areas, yet there is no reference to the source of such findings.
The story accurately describes the prevalence of cardiac arrest and its consequences. If anything, the article is guilty of “treatment mongering,” implying that bystander CPR would dramatically impact the survival of cardiac arrest sufferers, if only more people would get with the drill and learn it. Not so.
Everyone quoted in the article is an advocate of efforts to teach, learn and use CPR in bystander situations. Those perspectives are fine, but the story should have at least quoted or cited some source about the risks, downsides, and low survival rate of those who undergo CPR. The conflicts of interest are apparent: those quoted are all survivors, survivor advocates, or CPR trainers.
There are no exact alternatives to bystander CPR, but the bystander use of AEDs has been shown to vastly improve survival rates after cardiac arrest if used quickly. Obviously they are not widely available outdoors, but they are increasingly placed in airports, office buildings, schools, recreational and sports venues, and even department stores. Some mention of AEDs would have been welcome.
The article did not gather or report any information about the number of individuals already trained in Philadelphia or in other major cities (such as Seattle) where records have long been kept related to bystander CPR training and use. And while it says the need to train more people is “acute,” it doesn’t tell us whether the problem is a lack of available training sessions or the failure to take advantage of those opportunities. The lack of data contributes to the reader’s misunderstanding of the urgency for CPR training.
The story did not claim to reveal anything new or novel about CPR or its use among the survivors who were the subject of the story. But if there’s nothing new here, why run the story?
There’s enough original reporting here that we can be sure the story didn’t rely excessively on a news release.