Big Japanese Study Finds CPR Doesn’t Save That Many Lives

GeorgeLundbergMDYou’re going to keel over when you read this. Well, I hope you don’t because after reading it you may not want to be resuscitated. George Lundberg MD, Editor-at-Large at MedPage Today, says if he collapses on the street, he doesn’t want CPR:

Why Do CPR?, George Lundberg MD, MedPage Today, June 2012

He justifies his Do Not Resuscitate (DNR) request, in part, on this study of 417,188 people from Japan that experienced an out-of-hospital cardiac arrest, were treated by Emergency Medical Services (EMS) and taken to hospital:

Prehospital Epinephrine Use And Survival Among Patients With Out-of-Hospital Cardiac Arrest, JAMA, March 2012

Lundberg:

“Approximately 18% of those who were administered CPR and epinephrine did achieve spontaneous circulation but fewer than 5% survived 1 month and fewer than 2% survived 1 month with good or moderate cerebral performance.

So, if an average adult keels over in the street, is found unresponsive and pulseless by a bystander, and is administered CPR while a 911 call is made, the odds that such a person will emerge from the eventualities of the resuscitation effort healthy and with a normally functioning brain are about 2%.

The other outcomes are death — soon, or within 30 days — after lots of cost and much suffering for many, or being discharged from a hospital, alive but mentally impaired, presumably lifelong.”

The article was quite polarizing. I wonder if those on either side of the divide could be defined by age, where the young defend resuscitation and the old, well, wish to exit as masters of their domains.

6 thoughts on “Big Japanese Study Finds CPR Doesn’t Save That Many Lives

  1. Marj

    I’ve found this topic to be of great interest the last few years. Here is an article from the NYT in March 2013 that goes into it (the comments are interesting–as usual, varied opinions). It remains as to what can be done to ensure that the individual’s wishes are carried out. How is that possible when the first aim of bystanders (assuming it’s in a public place) is to save lives?

    Reply
    1. Bix Post author

      That was a great article, Marj. There’s so much to think about here. One of the kernels I got out of it was this:

      “One of the most important questions to ask is, what is the older person’s current level of functional ability and cognitive status,” Dr. Abella said, observing that “elderly patients with good precardiac arrest function tend to do much better.”

      … tend to do much better … if their heart failure happened while they were in a hospital. What if they are at the grocery store? And their brain was starved of oxygen for all those extra minutes before EMS arrives? God, it’s even hard to think about.

      Dr. Lundberg isn’t young, but he’s still sharp. That makes his desire not to be resuscitated surprising for me. Although, he did make the distinction of not having CPR out of a hospital setting.

      To be honest, I had no idea survival data was so poor, in or out of a hospital. It makes me want to take care of my arteries that much more, so as to not put anyone in the position of having to make this decision for me.

      There’s another thing here … how do we know we don’t want to be resuscitated? I mean, what is life like for people who had CPR and lived to tell? From your article:

      “Unfortunately, there is no research on how elderly survivors of cardiac arrest rate their quality of life and whether they would choose resuscitation again if they had the opportunity.”

      Reply
      1. Melinda

        I’m stunned–I had no idea either. I don’t know how to do CPR, and have kept thinking I ought to learn how. Welp, another standard idea down the tubes….

        Reply
  2. Melinda

    So, re being out in public, I guess you need “Do not resuscitate” tattooed on your forehead? How can the well-meaning public know your wishes? Confusing. Haven’t had a chance to read Marj’s article yet. I posted Lundberg’s article and the Japanese article on FB, asking a nurse-practitioner friend if this matched her experience (she’s worked for decades both in the ER and now accompanying wealthy, sick patients on air flights). She said “Absolutely true !! I can tell you that for sure anecdotally … We have a saying in my world … Living better thru electricity … Your best odds are a witnessed arrest with a defibrillator very close by and the presence of some electrical activity even if it’s chaotic ie ventricular tachycardia or ventricular fibrillation … CPR only in the field ? I bet I’ve seen maybe less than 5 people survive in the 10,000 yrs that I’ve worked in the ER.”
    Wow.

    Reply

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