why do we continue to do cpr????

[Dustdevil]

I just dont understand why they change it every 2 years .

Because, unlike most of the nimrods in EMS, they actually do continuous research into the science behind our procedures, as well as the evidence of their efficacy, in an effort to insure that our techniques are up-to-date, and represent the very best efforts we can give. If you don't understand that concept, see the "Monkeys and EMS" thread near this one for an explanation.

[mshow00]

Because, unlike most of the nimrods in EMS, they actually do continuous research into the science behind our procedures, as well as the evidence of their efficacy, in an effort to insure that our techniques are up-to-date, and represent the very best efforts we can give. If you don't understand that concept, see the "Monkeys and EMS" thread near this one for an explanation.

So let me see if I can paraphrase Dust here :twisted:; When it comes to ACLS- we, as well as our pts, are lab monkeys for someone in a suit?

[Dustdevil]

So let me see if I can paraphrase Dust here :twisted:; When it comes to ACLS- we, as well as our pts, are lab monkeys for someone in a suit?

I suppose so. However, I was not aware that God wears a suit.

[defib_wizard]

Dustdevil wrote;

I suppose so. However, I was not aware that God wears a suit.

If he does I bet the tie isn't a clip-on! :shock:

[sirduke]

I've been told he has a P on the end of his name though!!!

[zzyzx]

The original poster has received a lot of flack here for proposing that we stop CPR. There is actually a very good argument to be made for not trying to revive out-of-hospital cardiac arrests.

If you're interested in learning more about the arguments against CPR, check out "The Myth of CPR." I read this book a few years ago, and it really made me question a lot of what we do. Since the survival rate for out-of-hospital cardiac arrests is somewhere between 1 and 5 percent (the best numbers the author could come up with after looking at all the studies available when the book was written in '99), he argues that CPR is a huge waste of money that could be better used in other areas of healthcare.

I actually disagree with the author's conclusions. However, I don't disagree with the logic of his argument. It's more a philosophical issue. I just peronaly feel that we should try to do everything we can. Perhaps at some later date if the save rates for out-of-hospital cardiac arrests don't improve, then maybe we should rethink what we are doing. Healthcare costs are only going to continue increasing, and with the way things are going with our economy and debt burden, in the future it may not be possible to do everything we can for everybody.

Check out this Google Book link for more on the book...

http://books.google.com/books?hl=en&id...result#PPA28,M1

[AnthonyM83]

Just comes down to the price you put on the rare lives you do save. Big picture not a huge gain, but to the family and that person...well I'm sure they're very grateful. Sometimes I forget how diasterous loss of life can be...especially if it's a younger person (the type it seems gets revived with good out of hospital qualify of life).

My friend responded to a person down on basketbal court...male in 40s down...CPR started by bystanders...shocked...regained CONSCIOUSNESS right there. I'm sure to the EMS personnel, it was worth the time spent doing codes on others who had no chance of survival.

You say survival rate is 1 - 5 percent!? That's freaking good in my eyes.

[Arizonaffcep]

The original poster has received a lot of flack here for proposing that we stop CPR. There is actually a very good argument to be made for not trying to revive out-of-hospital cardiac arrests.

If you're interested in learning more about the arguments against CPR, check out "The Myth of CPR." I read this book a few years ago, and it really made me question a lot of what we do. Since the survival rate for out-of-hospital cardiac arrests is somewhere between 1 and 5 percent (the best numbers the author could come up with after looking at all the studies available when the book was written in '99), he argues that CPR is a huge waste of money that could be better used in other areas of healthcare.

According to the AHA,

"These statements are fair generalizations:

Early CPR and defibrillation (de-fib"rih-LA'shun) within the first 3–5 minutes after collapse, plus early advanced care can result in high (greater than 50 percent) long-term survival rates for witnessed ventricular fibrillation (ven-TRIK'u-ler fib"rih-LA'shun).

The value of early CPR by bystanders is that it can "buy time" by maintaining some blood flow to the heart and brain during cardiac arrest. Early bystander CPR is less helpful if EMS personnel equipped with a defibrillator arrive later than 8–12 minutes after the collapse.

Increased survival with CPR and AEDs

Studies have repeatedly shown the importance of immediate bystander CPR plus defibrillation within 3–5 minutes of collapse to improve survival from sudden VF cardiac arrest.

In cities such as Seattle, Washington, where CPR training is widespread and EMS response and time to defibrillation is short, the survival rate for witnessed VF cardiac arrest is about 30 percent.

In cities such as New York City, where few victims receive bystander CPR and time to EMS response and defibrillation is longer, survival from sudden VF cardiac arrest averages 1–2 percent.

Some recent studies have documented the positive effect of lay rescuer AED programs in the community. These programs all ensure adequate training, and a planned response to ensure early recognition of cardiac arrest and EMS call, immediate bystander CPR, early defibrillation and early advanced care. Lay rescuer AED programs consisting of police in Rochester, Minn., security guards in Chicago's O'Hare and Midway airports, and security guards in Las Vegas casinos have achieved 50–74 percent survival for adults with sudden, witnessed, VF cardiac arrest. These programs are thought to be successful because rescuers are trained to respond efficiently and all survivors receive immediate bystander CPR plus defibrillation within 3–5 minutes."

This DOES NOT INCLUDE TRAUMATIC ARRESTS, which of course, have a much lower rate of "recovery."

Here are some stats from Trauma.org in regards to ED Thoracostamys.

"Mechanism of Injury

For penetrating thoracic injury the survival rate is fairly uniform at 18-33%, with stab wounds having a far greater chance of survival than gunshot wounds. Isolated thoracic stab wounds causing cardiac tamponade probably have the highest survival rate, approaching 70%. In contrast, gunshot wounds injuring more than one cardiac chamber and causing exsanguination have a much higher mortality.

Blunt trauma survival rates vary between 0 and 2.5% and some authorities suggest that thoracotomy for blunt trauma should be abandoned altogether. However, this is an oversimplification of the literature. There is a distinct survival rate for patients with isolated blunt thoracic trauma who undergo emergency thoracotomy. This is highest for patients who are severely hypotensive in the emergency room and are exsanguinating from a chest injury. Blunt thoracic trauma causing traumatic arrest in the emergency department should also undergo thoracotomy. Whether this should be extended to those patients arresting in the presence of prehospital emergency services is debatable."

[medic61]

The real question (to me) is not "why do we continue to do CPR"- it is why do we continue to base the success/failure of our entire system of emergency medical care on cardiac arrest "saves"?

Isn't qualifying our value to society by how often we can actually 'resurrect the dead' a little ridiculous?

There are certainly a lot of things we do- and do well- that we should be proud of.

There are many things that we should be focusing more of our training/education/skill practice on, that could more realistically result in a better final outcome for more patients.

It would be interesting to know the percentage of required training we spend on CPR/ACLS, etc compared to the ratio that we actually use or need those skills on a daily basis- and on the reality of it's expected outcome.

I'm not advocating we stop doing CPR, especially on the sudden arrest of patients who are otherwise fairly healthy.

I just wish we allow ourselves to be judged by other values.

You don't often see hospitals judged by their number of "saves"- and they not only deal with more cardiac arrests, but they are usually witnessed arrests and have better chance of a good outcome.

[katbemeEMT-B]

To the OP, first off, you might benefit from a couple of english classes and learn how to spell. Please use the spellcheck button. It makes reading a post much easier when words are spelled correctly.

Now that I have that off my chest...while it is impossible to achieve a 100% save rate in cardiac patients, isn't it feasible to continue CPR even if it's for a minute amount of people. How else is the medical research profession able to collect data and find ways to improve life saving procedures if we as "medical professionals" decide, "well, we don't like doing CPR as it doesn't have a high success rate"? If we were able to pick and choose who we do CPR on, how would we choose? Does the 80 year-old grandma get a no because she's a train wreck, while the 40 year-old mom down the street gets a yes because she's hot? Where would we draw the line? And if we discontinued CPR altogether, I would have had to say goodbye to a friend this summer. Guess what, she was my first save and suffered no deficits. And let's look at this from another angle...if CPR is useless, than should we also let the patient with multiple traumas and basically no chance to survive lay on the roadway and die or do we do everything within our powers to stabilize the patient and get him/her to a trauma center only to find out later that he/she died?

It comes down to this, advancements in medicine have allowed people to live longer and we expect that ANY medical professional will do ALL that they can to keep us that way. If you as an individual chooses not to have extraordinary measures taken to keep you alive, that's your choice and you should ensure that you have the paperwork to voice that opinion. Until such the day that we actually become paraGods, it is not up to us as to who lives and who doesn't. We are there to provide a service, sometimes as fruitless as it may seem, but none-the-less, it's our job.

I could go on and on, but I don't think it would make a difference. I do think that if you truly feel this way, you need to find a different profession for the benefit of any patients you encounter and for yourself.

P.S. Found four spelling errors in my post with spellcheck.