CPR: More than Staying Alive

Life is about knowing when to roll the dice. CPR survival rates are lower than the odds of guessing a number correctly if you toss one of those dice. But CPR is still a skill everybody should learn.

Sunlight filters through the cottonwoods, and the babble of water echoes in your ears. The laughter of 20-somethings blends in with the sounds of the rushing water. The peace is shattered as one of the laughs transforms into a scream. You watch in terror as an unconscious young man is pulled to the riverbank. One of his friends is screaming, “Jacob isn’t breathing!”

Most people aren’t first responders, so TV and other media fill in the blanks. About 95% of people learn about CPR from TV. You might remember seeing Damar Hamlin getting CPR on Monday Night Football. Or you may recall scenes post-CPR on medical dramas, the doctors with perfect hair saying everything will be ok.

If you’re lucky, you think of NBC’s The Office’s first aid failure and remember that you need to push on his chest hard and fast to the beat of the “Staying Alive.” Unfortunately, you are frozen.

Another bystander dials 911, and paramedics arrive, start CPR, and take him to the hospital. You probably think things are going to be ok now. Research shows most adults think CPR has a 75% chance of success but, unfortunately, the odds aren’t in his favor.

When CPR is done outside of the hospital, about one in ten people survive. In the hospital, between two to four out of ten survive . Though the odds are nowhere close to assumed success rates, immediate CPR increases survival rates significantly, by three to four times. Per Timothy Meyers, M.D., the Chair of Emergency Medicine at Boulder Community Health, “The sooner the CPR gets started, the higher the success rate in terms of outcomes.”

What is CPR, really?

The heart beats over 10,000 times daily to move 2,000 gallons of blood over 60,000 miles of blood vessels to deliver oxygen and nutrients and remove waste. A stop in this flow is deadly. 

“[People who have a] prolonged downtime [before CPR begins]…  unfortunately don’t have a good neurological recovery… it’s a life-changing event for them. The success rate of CPR undoubtedly goes up if it’s started within the first two minutes [of the heart stopping].” Said Dr. Meyers. 

Brain cells begin to die when deprived of blood flow for around four minutes, causing irreversible damage. Death follows minutes to seconds after brain cells die. CPR moves blood in the body when the heart cannot, hopefully keeping cells alive.

“The technique itself is really pretty straightforward… The biggest goal is to restore blood flow quickly by pushing on the chest, which indirectly compresses the heart…[which] stimulates the blood to start flowing around the circulatory system again.” Explained Dr.Meyers.

High-quality compressions must be both hard and fast. Compressions must push the chest down two inches and be done 100-125 times every minute. Think about pushing to the beat of “Stayin’ Alive.” Or, if you’ve spent any time around a toddler, “Baby Shark” might be easier to remember.

“CPR used to be equally focused on breathing and compressions fairly early on…We really have sort of moved away from that.” Continued Dr. Meyers. Good news for bystander CPR. There are only two steps to take, dialing 911 and starting chest compressions.

CPR success is greatly enhanced when it is paired with a defibrillator, a medical device that helps reset the heart. Fortunately, defibrillators are widely available outside of doctors’ offices and hospitals.  Most businesses and public spaces like libraries and schools have Automated External Defibrillators (AED’s) on their premises. The Colorado Legislature passed HB1183- Automated External Defibrillators In Public Places in 2019 to help expand access.

CPR is a lifesaving tool, but it isn’t without risk. “Broken ribs are certainly fairly common after CPR… [along with] rib pain, [and] rib injury,” Clarified Meyers. These broken ribs can puncture nearby organs such as the lungs. But these risks should not be seen as a deterrent if a person suddenly collapses. “Especially if it’s a family member or a loved one, why not give them that chance?” 

Pushing Deeper  

TV mostly shows young CPR survivors. One study found an average age of 36 years shown in medical dramas. They suffered accidents like almost drowning or a car crash, but were otherwise healthy. CPR works best for these patients. It also works well when there is a problem with the heart itself, like a heart attack or cardiac arrest like Damar Hamlin. CPR keeps people alive so these reversible problems can be fixed.

When the heart stops due to cancer, heart disease, or another irreversible chronic illness, CPR survival rates are abysmal, only one in one hundred compared to typical odds. These survivors rarely return to their former quality of life. Sometimes the damage to the body to the body before CPR makes people completely reliant on life support or even causes brain death. An especially cruel irony for those whose conditions leave them with only months to live.

“You can’t get around it. [CPR] is violent. People say, ‘Oh, don’t use those terms.’ [As if] somehow, by telling people this, you’re manipulating them. But no, you need to tell them.” Explained Rebecca Gagne-Henderson, Ph.D. a Nurse Practitioner (NP) with 27 years of experience in palliative care and hospice care.

For those with reversible conditions, CPR’s pain is a small price to pay for a second chance at life. But is it a price worth paying for those who have weakened bodies from irreversible conditions, who only have months to live?

“I have only seen one [patient], who was on palliative care actually survive… and leave the hospital. She went to the nursing home, and she was going to be bedbound. And the son was like ‘see you were wrong. You were wrong.’ She died two weeks later. What did those two weeks look like, for her?” said Gagne-Henderson. When it comes to staying alive- should we prioritize the length of time? Or the quality? 

It can be hard to breach the conversation of quantity vs. quality of life, even for doctors. Gange-Henderson reflected “When I would round as the palliative NP [in the] ICU… I would listen to the residents giving report [on patients with complete life support measures who were] a full code! And that’s when I would say, ‘I have a question…Do you think that your patient is a candidate for CPR?’ It’s something they hadn’t even considered!” Said Gagne-Henderson while shaking her head

“[Families often] want CPR,  because it will make them well. So I would ask them, ‘What does well look like to you?’  and for me, I wouldn’t want CPR if afterward I couldn’t get up and make a cup of tea and care for myself… if I can’t do that, then CPR is going to make my life worse.”  Said Gagne-Henderson.

Conversations about if CPR fits in with wishes for what wellness means can begin with a primary care physician. While it’s a conversation that can be difficult, knowing what life-saving measures fit for each person ensures everyone’s transition from life to death is peaceful. 

What to do if somebody needs CPR (A refresher for the CPR certified and and introduction to all others)

Let’s go back to Boulder Creek Trail. We now know it’s critical to get emergency aid to Jacob right away. Do not wait for somebody else to act. Try to wake the unconscious person up by shaking their shoulder. If they are not responsive, check for a pulse on the unconscious person’s neck. If there is no pulse, it’s time to act fast to save a life.

If others are around during a medical emergency, enlist their help. In Jacob’s case, point at one of his friends and tell them to dial 911. Point to another, and tell them to go to a nearby building and see if they have AED. Directly pointing at people and telling them what to do may seem rude, but it helps prevent people from freezing during an emergency. The vast majority of public spaces like schools,libraries, and businesses have AEDs on their premises. Most AEDS will give users verbal instructions, and if they don’t 911 operators can give instructions. If the unconscious person is wet, try to dry the victim’s chest before applying AED pads. 

Once 911 is called, and an AED is on the way, it’s time to start 2-inch deep chest compressions. Push to the beat of “Stayin’ Alive” or “Baby Shark.” Try not to pause for more than 10 seconds. While it may seem weird not to give rescue breaths, new research points to hands-only CPR being just as effective.

If you’re by yourself and have a phone dial 911 before starting chest compressions. If you’re by yourself without phone access, do chest compressions for 2 minutes before finding a phone and calling 911 for help.The best way to learn CPR is by taking a class. Classes are available through the American Heart Association and The Red Cross. 

In the case of Jacob, quick CPR and a shock from the AED resulted in a bewildered man coughing up water as paramedics reached the scene. He was taken to a hospital and diagnosed with broken ribs but will go on to enjoy another day with sunshine through the cottonwoods. Hopefully, doing more than just stayin’ alive.