Real CPR Isn't Everything It Seems to Be

From the WebMD Archives

May 14, 2001 -- Hospital dramas like ER, Gideon's Crossing, and Chicago Hope do a lot to make viewers aware of what happens during an emergency situation. However, these shows may be contributing to unrealistic expectations of what cardiopulmonary resuscitation, commonly known as CPR, can do -- by inflating survival rates.

The truth is that only between 5%-10% of people who undergo CPR will survive, while on television shows, a majority of the patients seem to do well.

"A lot of patients we see in the emergency department and a lot of families that we interact with do not always have realistic ideas about the success rate associated with CPR," says Amal Mattu, MD, assistant professor of emergency medicine and co-director of the emergency medicine/internal medicine combined residency program at the University of Maryland School of Medicine in Baltimore. Mattu speaks regularly on this topic.

"Most people in the public and even nurses and physicians ... overestimate the success rate of CPR, and part of that is probably due to the way that CPR is depicted on television," says Mattu.

CPR involves the use of mouth-to-mouth breathing and chest compressions to facilitate the continued circulation of oxygenated blood throughout the body. It is performed when the breathing or the regular heartbeat has stopped -- for reasons such as electric shock, drowning, or severe trauma.

In sudden cardiac arrest, when the heart stops functioning properly, the heart goes from a normal heartbeat to a quivering rhythm called ventricular fibrillation, which is fatal unless an electric shock, called defibrillation, can be given.

Defibrillators are devices that deliver electric shocks when needed to correct abnormal heart rhythms through pads that are placed on the patient's chest.

CPR is really a stopgap measure that extends the window of survival until trained medical help arrives and advanced equipment can be used. It does not stop ventricular fibrillation but it extends the time in which defibrillation could be effective. Permanent damage to the brain can occur if oxygen flow is not restored within about five minutes, and with CPR, oxygen flow is maintained.

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But despite CPR being less effective than you might think, it is still worth trying, experts tell WebMD, because doing anything in an emergency situation is clearly better than doing nothing. "Chest compression and CPR will buy them a little extra time," Mattu says.

And, "if there were more defibrillators that were easily accessible, it probably would save a lot of lives," he adds.

Currently, groups like the American Heart Association are lobbying to have defibrillators placed in heavily trafficked public areas such as airports and stadiums.

Many people are nervous about doing the mouth-to-mouth part of CPR on strangers, Mattu says. "Even if all you do is chest compression, that's clearly better than doing nothing," he tells WebMD.

"CPR is the only thing that a lot of people are capable of doing in an emergency situation," says Sarah Gillen, a vice president of Emergency Skills Inc., a corporate safety training group based in New York City. "We may expect it is going to do amazing things, and if everything goes well, it could. If you do nothing this person won't survive, if you do something they have a chance," she says.

And Gillen adds that in spite of the fact that outcomes of CPR are often wrongly portrayed on TV, the techniques shown are about right.

Still, nothing is better than hands-on training. Gillen tells WebMD that anyone can learn CPR through a training program. "A training course where you can practice is invaluable in an actual emergency," she says.

So what is the best way to respond to an emergency?

  • If someone has collapsed and is unresponsive, call 911 immediately.
  • Then CPR should be administered when someone's breathing or pulse stops, Gillen says.

The American Heart Association currently recommends the ABCs of CPR -- Airway, Breathing, and Circulation.

  • Airway: If a person is unconscious, check the airway by gently tilting the head back with one hand and lifting the chin with the other. Check for breathing. If the person is breathing, roll him onto his side and wait for help to arrive.
  • Breathing: If the victim is not breathing, begin mouth-to-mouth resuscitation. Keeping the victim's head back and chin up, pinch the nose. Form an air-tight seal with your mouth on the victim's mouth and give two slow breaths.
  • Circulation: Begin chest compressions. Depress the lower half of the sternum straight down about two inches. Then completely relax the pressure on the sternum, letting the chest rise to its normal position between compressions. Perform 15 chest compressions followed by two slow breaths. Complete this cycle four times, for about a minute. Then check for a pulse and see if the person is breathing. Continue until help arrives, or if the person has a pulse and starts breathing, rotate them onto their side into what's called a recovery position.

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The best way to know what you're doing is to take a CPR class. Doing CPR when you're not sure of the procedure can be dangerous to the patient. For information on taking a CPR training class, contact the AHA toll-free at 1-877-AHA-4CPR

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