Post 51: Three Ways to Perpetuate CPR Myths
Updated: Dec 16, 2021
Sometimes it seems that we medicalize unpleasant or undesirable aspects of being a human being. One that comes to mind is grief. Concerned family members may feel helpless when they see their loved one cry and ask if there is a pill that could take away this "depression" (when grief itself is actually a normal human emotion for which there is not a medical treatment). Another that comes to mind is dying. We talk about "resuscitating" (which means "reviving"), "bringing back," and "saving a life" when someone goes into "cardiac arrest," as if cardiac arrest is just another medical disease or complication. But really when a person goes into "cardiac arrest" (which means "heart stopped"), they have "died" or "passed away" or "let go."
People in the United States who go into cardiac arrest (that is, people in the United States who die) automatically receive the following unless they opt out (read Post 6: Who Do I Tell if My Mom Does Not Want Resuscitation Attempts? - A Three Step Process):
1. chest compressions (a helpful bystander locks their elbows and pushes down hard a couple inches in the middle of the chest 100 to 120 times per minute to squeeze blood out of the heart with each push in an attempt to send oxygen-containing blood to the brain)
2. rescue breaths (a helpful bystander tilts the head back, pinches the nose, and blows air firmly into the mouth until the chest rises indicating air is going into the lungs rather than the stomach) - realistically, many people feel hesitant about giving mouth to mouth to a stranger, so the American Heart Association says, "If you don't want to do mouth to mouth, please do chest compressions at least!"
3. shocking the heart through the chest with a moderate amount of electric volts if the heart is in a certain type of non-life sustaining rhythm, meaning the heart is quivering like jello instead of pumping blood to the brain and organs (a helpful bystander grabs an "automated external defibrillator" - also called an "AED" - that is hopefully located close to the body, and follows the instructions on the machine, specifically to place defibrillator pads at the correct locations on the bare chest so that the defibrillator pads can analyze the heart's rhythm through the chest and instruct the helpful bystander to either press the button to shock or to not shock).
I want to give a heads up that some people may not want to read the following statistics about CPR and resuscitation, that it may be disconcerting to some, and if so, consider skipping to the last two bold faced sections (I list sources for data at the end of the post).
Depending on how old a person is when their heart stops, how strong or frail the person's body is, the number and severity of medical issues the person has, and the conditions in which the person's heart stops functioning, the expected rate of being able to get the heart beating normally again, making it to the hospital, surviving through the hospitalization, and leaving the hospital alive without significant brain damage ranges from less than 1 in 100 to 45 in 100 (1)(2), overall 9 in 100 for the whole population (3)(4).
These are not commonly discussed numbers, and in fact over half of the population believe CPR is successful over 75 of 100 times (5). Most elderly people older than 70 years old believe that the chances of being able to be resuscitated with CPR and eventually leaving the hospital alive is more than 50 of 100 (6).
Why is there such a discrepancy between what we believe about CPR success rates and the reality of CPR success rates? Since we rarely ask for, look up, or discuss information about CPR, we absorb most of our information by default from the only place where CPR information is given - from TV and movies. In fact, people's beliefs about CPR success rates are in line with the rates of CPR success on TV; there are numerous studies analyzing CPR accuracy in medical dramas and movies.
Even healthcare providers overestimate CPR success rates (CPR data is not taught in school nor in training). Nurses believe CPR is successful 30% of the time, which is triple the actual average, and physicians 24% of the time, which is double the actual average (7).
Some people also assume CPR can be "quick," "gentle," or "easy," all myths perpetuated by the media (which I touch upon in Post 5: CPR on TV versus CPR in Real Life - Three Ways They Differ). The following are three ways CPR myths are perpetuated on TV and in the movies:
1. Portray CPR actions on TV as intuitive (any character, regardless of training, jumps in and starts pressing on the chest) with fast response times from those who just had CPR done to them (the character whose heart just stopped opens his eyes and asks, "What happened?" within seconds after having died and received a couple pushes on the chest).
Researchers analyzed 136 cardiac arrests in 174 episodes of the medical drama ER from seasons 2001 to 2009. Only 1 CPR scene followed American Heart Association guidelines (8).
In real life, the rate of CPR success increases from 10 in 100 to 33 in 100 if chest compressions are performed and the AED (defibrillator) is used correctly. However, only 1 in 3 people whose heart stops outside the hospital actually receive CPR from bystanders, and only 3 out of 100 people are appropriately treated with an AED before paramedics arrive (3).
In addition, if a person whose heart and lungs stopped working is able to get their heart functioning again, they still need lung support. They immediately have a breathing tube placed for breathing assistance, and they are taken to the intensive care unit of the nearest hospital to be connected to the ventilator (also called "breathing machine" or "life support"). Only on TV, does a person instantly open their eyes and start joking.
2. Depict those needing CPR on TV as young, healthy, and vibrant looking.
Researchers analyzed Grey's Anatomy and House medical drama episodes between 2010 and 2011. CPR was depicted 46 times in 91 episodes, and over 60% of the people who went into cardiac arrest were young, less than 65 years old (9). In real life, over 60% of people whose hearts stop are elderly, older than 65 years old. In real life, most people whose hearts stop have many underlying health issues or end stage disease. On TV, over 1 in 3 people are healthy with no underlying medical illness at the time that their hearts stop (9).
Among Chicago Med (41 episodes), Code Black (34 episodes), and Grey's Anatomy (48 episodes) during the 2015-2107 seasons, 106 resuscitation/CPR attempts were analyzed. 55% were due to trauma (4), whereas very few cardiac arrests in real life (2%) are due to a readily identifiable, potentially fixable trauma such as blood loss from a motor vehicle accident or a surgically repairable gunshot wound (10).
So the gist is people whose hearts and lungs stop on TV are primarily young, without many medical issues, and have a sudden, easily identifiable, potentially reversible or fixable cause for their cardiac arrest/ death, whereas in real life people whose hearts and lungs stop are usually frail, older, with multiple medical issues or end stage medical diseases, and have no easily reversible or fixable cause for their cardiac arrest/ death.
3. Provide an ending with resolution. Those who receive CPR on TV are either resuscitated and resume living their normal life at home OR they are not able to be resuscitated and they are mourned. Hardly anyone "lingers" on TV.
When researchers analyzed 70 CPR attempts on 4 medical dramas including Grey's Anatomy and ER during the 2008-2009 season, characters were portrayed as either dying or making a full recovery. The potential in-between (brain damage from lack of oxygen during CPR attempts or a prolonged recovery period or a new normal in which a person can no longer be independent) were rarely shown (11).
It is a big, big deal if somebody's heart and lungs stop, and it is an even bigger deal if there is any delay in resuscitating the heart and getting oxygen to the brain. In real life, the "in-between" are more likely scenarios than a full recovery to independent functioning if someone's heart is able to be resuscitated.
We use whatever information we are given to make big healthcare decisions, including those involving CPR. Even not making a decision, thus allowing CPR to become our default path rather than deliberately opting for CPR, is in itself making a choice. Unfortunately, the majority of our information are from TV medical dramas and movies, which tend to glamorize and not accurately depict the realities of CPR resuscitation attempts. I hope this post provides helpful information as a first step towards making informed decisions about CPR at every stage of our lives (our decisions as a 40 year old woman may differ from our decisions as an 80 year old woman; our decisions as a person with no medical issues may differ from our decisions as a person with advanced lung disease), which are essentially about making decisions of what our final moments may look like and the way we die.
(1) Cadogan MP. CPR Decision Making and Older Adults. Journal of Gerontological Nursing 2010; 36(12): 10-15.
(2) Landry CH, Allan KS, et al. Sudden Cardiac Arrest during Participation in Competitive Sports. N Engl J Med 2017;377(20): 1943-1953.
(3) McNally B, Robb R, Mehta M, et al. Out-of-hospital cardiac arrest surveillance - Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010. MMWR Surveill Summ. 2011, 60:1-19.
(4) Bitter CC, Patel N, et al. Depiction of Resuscitation on Medical Dramas: Proposed Effect on Patient Expectations. Cureus 2021;13(40): 14419.
(5) Bandolin NS, Huang W, et al. Perspectives of Emergency Department Attendees on Outcomes of Resuscitation Efforts: Origins and Impact on Cardiopulmonary Resuscitation Preference. Emerg Med J 2020;37: 611-616.
(6) Adams DH, Snedden DP. How Misconceptions Among Elderly Patients Regarding Survival Outcomes of Inpatient Cardiopulmonary Resuscitation Affect Do Not Resuscitate Orders. J Am Osteopath Assoc 2006;106: 402-404.
(7) Roberts D, Hirschman D, et al. Adult and Pediatric CPR: Attitudes and Expectations of Health professionals and Laypersons. Am J of Emerg Med 2000;18(4): 465-468.
(8) Hinkelbein, J, Spelten O, et al. An assessment of resuscitation quality in the television drama Emergency Room: Guideline non-compliance and low-quality cardiopulmonary resuscitation lead to a favorable outcome? Resuscitation 2014;85:1106-1110.
(9) Portanova J, Irvine K, et al. It isn't like this on TV: Revisiting CPR survival rates depicted on popular TV shows. Resuscitation 2015; 96: 148-150.
(10) Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests form the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003;58:297–308.
(11) Harris D, Willoughby H. Resuscitation on television: Realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama. Resuscitation 2009; 80: 1275-1279.