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The dark side of CPR: Why doctors now say it could do more harm than good
By Ben Cost nypost.com
May 30, 2023 12:52pm Updated
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The world’s most famous life-saving rescue technique could be worse than death in many cases, according to a new report.

Administering CPR — or cardiopulmonary resuscitation — to a cardiac arrest sufferer might seem like a no-brainer. However, mouth-to-mouth resuscitation could paradoxically cause more harm than good, according to a disturbing new NPR investigation.

“The bad experiences far outnumber the good ones, unfortunately,” Holland Kaplan, a physician and bioethicist, told the outlet about the so-called dark side of CPR.

Not only is this revival method not as successful as portrayed on countless televised medical dramas — but it can leave many patients with lasting physical and cognitive impairments.

On classic TV shows such as “ER” and “Grey’s Anatomy,” CPR — compressing a patient’s chest to circulate blood during cardiac arrest — is oft-depicted as a fool-proof method of revival, on par with “True Love’s First Kiss” in “Snow White.”

In actuality, this so-called time-honored technique has long caused a host of complications, including “fractured or cracked ribs,” pulmonary hemorrhage, liver lacerations and broken sternums and most, frighteningly, brain damage, per a 1961 Johns Hopkins Study.

The American Health organization estimates that CPR can cause neurological disabilities in up to 20 percent of cases.

CPR’s potential side effects are so bad that many patients — and even doctors — often refuse the treatment on themselves.

This is a far cry from CPR’s wider reputation in medical circles, in which it’s seen as a simple “two-handed” method that makes death “manipulable” by humans, according to sociologist and CPR expert Stefan Timmermans, NPR reported.

First described in medical literature circa 1878 following successful experiments on cats, CPR became the de facto method of restarting the heart in cardiac arrest patients, with official CPR classes becoming available to the public in the 1970s.

To this day, professionals ranging from daycare staff to prison personnel are often required to be CPR-certified.

Noted bioethicists wrote in 2017 that CPR was seen as so crucial that refusing to administer it might appear “equivalent to refusing to extend a rope to someone drowning,” according to the American Journal of Bioethics.

These popular perceptions are amplified by media and TV.

In another previous study, researchers found that the survival rate after CPR on TV was 70%, while people believe in real life that the number is north of 75%, NPR reported.

These results conflicted with a 2010 study, which found that overall rate of survival from out-of-hospital cardiac was 7.6%, and had been that way for three decades, NPR reported.

Meanwhile, the post-CPR survival rate for in-hospital treatment was only marginally better, clocking in at about 17%, while fewer than 2% of patients with preexisting conditions such as cancer or heart, lung and liver disease were revived via CPR. In general, older patients fare worse as well.

“This is the truest of emergencies and you give people the simplest of procedures,” Timmermans told NPR of the “too good to be true” technique.

Not to mention that getting revived via CPR doesn’t preclude patients from experiencing life-threatening complications — some of which stem from the pressure required for its application,

“CPR may cause broken ribs or a fractured sternum (chest bone),” the American Academy of CPR and First AID writes. “This happens because the chest wall is compressed during compressions, and this can result in bone fractures.”

Another possible unintended consequence is a pulmonary embolism, which occurs when a clot breaks off and makes its way through the bloodstream before embedding in an “artery leading from your heart (pulmonary) or brain (cerebral).”

Most concerning, perhaps, is the neurological impact.

Permanent brain damage reportedly begins within four minutes of the heart stopping, so doctors often revive the blood-pumping muscle, only discover that the brain is dead.

Meanwhile, the constant stopping and starting of blood flow during CPR can also lead to brain swelling.

Approximately 30% of survivors of in-hospital cardiac arrest will experience severe neurological impairment while only 2% of survivors over 85 avoid traumatic brain damage,

This cardiovascular Catch-22 is the reason why many cardiac arrest patients are against receiving CPR altogether.

Up to 50% of survivors reportedly claim they wish they hadn’t been administered it despite living to tell the tale, according to a 2014 study.

Ok, there can be side affects. The alternative is death. Take your pick.

I have brought people back to life with CPR. If you know what your are doing it is a life saver. One girl I brought to life right after a car accident might have benefited from me doing nothing as she died three hours later and the medflight to the hospital cost her parents 19,000 dollars.

This ^^^

My personal physician had a heart attack at age 43 while driving his car. Luckily there were two nurses driving behind him who saw the car crash. They administered CPR and brought him back, he survived with no ill effects and retired at age 65, in 2012. AFAIK, he's still alive.

Given that the alternative is death, I'd rather they at least tried. Though I wouldn't hesitate to give a DNR if I was in hospital for a major procedure that might result in me being severely disabled if I survived.

Yeah, NPR...that's a source I'd trust for medical info. Not.

No mention in that article of who actually did the study, methodology, length of time of the "new" study, or who paid for it, if it even exists.

Ed

CPR has risks as mentioned. I think competent people should have a right to choose whether to be a DNR. And that decision may be changed over time based on circumstances. In my line of work, I know people who are nearing 100 years of age who still choose to be a full code. So if we find 97 year old grandma without vital signs lying in her bed, and she does not have a DNR order, then we have to initiate CPR. CPR can't be stopped until EMS or a medical doctor calls it. In the meantime, the frail little grandma is broken to pieces.

My buddy was on the phone with 911 the whole time
he revived his wife and kept her alive until EMTs came.

I was involved in CPR on about 400 patients, when I worked as a Paramedic. About 10 of those patients walked out of the hospital. And in most of those cases CPR was only administered for a minute or two. I can still hear, and feel those ribs cracking as I destroyed the chest of some 75 year old patient.

If y'all would read the article you will see that CPR almost never saves a patient, but it can cause a lot of harm.
I have a living will and the first sentence is "No CPR."

You guys know about CPR as a miracle life saver from watching Gray's Anatomy. Gee, it always works on those tv shows, doesn't it.

The Campfire "Ignorance Is Bliss" school of emergency medicine.

I know CPR from having to do it on several occasions as a law enforcement officer and as a passerby who came across bad wrecks.

Does it do damage? Hell, yes!

But then, if the person weren't already dead, we wouldn't be doing CPR on them!

Just my $0.02.

Ed

DUH


I thought they’d cite increased risk for COVID

Any alternative? Defibs?

Most civilians are incapable of finding a pulse on a person, even if there is a good pulse. And it is twice as bad when there is an apparent emergency. In many "CPR Saves" the patient's heart had not stopped beating. Well meaning bystanders started chest compressions creating a dire danger to the patient.

The paramedics get to the scene, stop CPR and find a good pulse, CPR is called off and the case goes down as a CPR save, when the patient is lucky the CPR didn't kill him, and he never needed CPR in the first place.

We paramedics called CPR "One of the greatest hoaxes ever pulled on the American people."

Let me die

Surplus population and such

It is a value judgement that everyone needs to think about and decide for themselves about what they want done to them when the time comes.

I have myself seen and inflicted all of the CPR damage described in the article.

There is a big difference between witnesses doing timely CPR on a previuosly healthy active 43-year-old man and an 88-year old who has been on the ventilator and vasopressor infusions for the last week or two.

I have told families, We'll run in there and run through the drill if you want us to, but you're not gaining them anything.

the only "Harm" would be if the person didn't need CPR to start with and someone did it anyways, breaking ribs that didn't need breaking. Otherwise, like said above, IF CPR is needed and not done, death is the outcome.

CPR can do more harm than good. CPR can do more good than harm.

What percentage of people who needed CPR and got it survived?

What percentage of people who needed CPR and didn't get it survived?

Hopefully, that's not the thought process that is used when confronted with a warm, non-reponsive person with no pulse and not breathing.

Ed

Well, yeah….

Mouth-to-mouth has arguably been left out of the procedure. Secondly, the CONTEXT of the scenario is everything including victim’s age, time on the ground; a geriatric with a living will with a “DNR” that is part of a known medical record, etc., and other factors all figure in.

Who’s going to watch an apparently healthy 40-60 y/o tip over and not try?

Thirdly, you don’t have to bust ribs and sternums to compress the heart. Yes, it happens.

I spent 14 months away from home with mainly respiratory problems. Part of that time was in a nursing home. The nurses there contended if you’re not breaking ribs or the sternum, you’re not doing it right. Most non staff are aged and tend to be frail.