8 Things You Should Know About CPR

CPR, or cardiopulmonary resuscitation, is one of the world’s best-known emergency medical procedures. You’ll see it in action in many movies and TV shows when lives are on the line. It’s a real procedure that has literally saved millions of people worldwide, and up-to-date certification in CPR is a legal requirement in many industries and professional roles. It’s also something that surprisingly few people are trained in, and many aspects of it are poorly understood or even misunderstood.

Let’s take a few minutes to unpack some things many people don’t realize about CPR.

It doesn’t restart the heart

This might seem odd to some, but many people assume that the goal of CPR is to get the heart started – pushing down on the heart to try and “wake it up” and get it to start beating again. Like banging an electrical appliance to get it to work again.

In reality, CPR won’t restart anyone’s heart. In most cardiac arrest cases, the heart hasn’t actually stopped. It’s normally in a state of what’s called “Ventricular Fibrillation” – the heart muscles are convulsing and quivering rather than beating regularly, meaning the heart rhythm is out of sync and the heart isn’t pumping any blood. CPR has no effect on this.

The actual purpose of cardiopulmonary resuscitation is to pump blood around the body. The reason Cardiac Arrest is so deadly is that your brain needs a constant flow of oxygen-rich blood, or it very quickly begins to shut down and die – generally within a few minutes. When the heart stops beating or the person stops breathing, this is what’s going to kill you.

CPR combats this by providing an emergency supply of blood to the brain. Pushing down on the chest moves the blood through your arteries, giving just enough oxygen to the brain to sustain it for a while. So basically, you’re keeping the person alive as long as you can by doing the heart’s job while it’s out of action.

It is true that sometimes people wake up and recover after someone’s been doing CPR on them, but that’s actually just their heart restarting all by itself (known as return of spontaneous circulation, or ROSC). All the CPR did was keep them alive long enough for that to happen.

It doesn’t work on its own

Because CPR keeps the person alive but doesn’t actually revive them, other help is needed to bring them back. While there’s a chance of them recovering on their own if you keep them alive, the odds of this aren’t great. Generally, their best chance at survival is defibrillation.

While ambulance paramedics will normally have a defibrillator with them, the person’s odds of survival go down every minute you’re waiting for an ambulance. Fortunately, many public venues now have automated external defibrillators (AEDs) available, meaning you can potentially have them hooked up within a minute or two of them collapsing – greatly increasing their survival odds. These are designed to be used by untrained bystanders and have simple instructions – often spoken out loud by the unit. They also scan the patient and decide when a shock is needed, so you don’t need to figure that out yourself.

Many people still die

It’s worth bearing in mind – as much as CPR can improve someone’s chances of surviving, their chances still aren’t great. TV and movies have led many people to believe the odds of CPR reviving someone are very good – about 75%, according to some studies. In reality, the odds are a lot worse. Statistically, only around 1 in 10 people receiving CPR survive and recover. So if you’ve given CPR to someone and they didn’t make it, it’s almost certainly not your fault.

The reason it’s still valuable is that 10% odds of surviving is a lot better than no chance of surviving! With millions of people suffering cardiac arrest in any given year, a one in ten chance still means hundreds of thousands of lives being saved.

Not everyone survives unscathed, of course. Something that TV and movies rarely covers is that often survivors of a cardiac arrest can still suffer significant brain damage from lack of oxygen to the brain – which is one of many reasons why starting CPR and defibrillation as early as possible is important, as it lessens the chances of this.

You don’t always need rescue breaths

In some cases, it’s not actually practical to perform rescue breaths (the part where you blow into the victim’s mouth) on someone suffering cardiac arrest. There might be infectious materials on the mouth, damage to the face or cheeks, or even cultural reasons why a first responder may be unwilling to do it. In such cases, is the casualty simply doomed?

No. Recent studies have shown that in many cases, compression-only CPR – where you perform chest compressions but not rescue breaths – is still a valid and effective way to perform CPR. Because the blood already has useful oxygen in it, circulating THAT blood will still help. And chest compressions do force some air in and out of the lungs, which also helps. Some statistics show the survival rate for compression-only CPR to be not much different to full CPR. So even if you’re in a situation where rescue breaths are not really a practical option, compression-only CPR is still a good option.

However, it’s worth remembering that there are some situations where compression-only CPR is not effective – drowning being one of the most common examples. As such, if you CAN do rescue breaths, the person’s odds are better if you do.

It’s both old AND relatively recent

While some elements of CPR only date from the 1960s, others have been around far longer. The idea of rescue breaths has been around for centuries – it dates from the 1700s and was used by doctors to save drowning victims. It was actually made popular by doctors such as Thomas Cogan and William Hawes – most famous for setting up the Royal Humane Society.

The idea of using chest compressions to supply blood to the brain, however, is far more recent. That concept dates from the 1960s and first appeared in a 1962 training video called “The Pulse of Life”.

Initially, it was just intended as a technique for doctors and medical professionals to use – normally in hospitals. But it proved to be so effective that it quickly spread through the worldwide medical community, and then in the 1970s, began to be promoted for use by the general public. Nowadays, it’s an essential element of first aid training (often offered as a stand-alone course).

If you’re not sure, you should perform CPR

A common fear for people confronted with a possible cardiac arrest victim is not being sure what’s wrong or if CPR will help. People are also wary of pushing hard on a stranger’s ribcage, fearing that they might do more harm than good – potentially bruising their chest or even breaking a rib if they get something wrong.

The opinion of the modern medical community is this: If in doubt, do CPR! A 2012 study in Japan found that out of 910 cases of CPR delivered by bystanders, only 26 cases were found to be unnecessary. Of those cases, only three caused an injury (including one minor rib fracture), and none of the injuries were serious. So you’re around thirty times more likely to save someone’s life with CPR than you are to injure them needlessly.

That’s a risk worth taking!

You won’t get sued

Another fear people have is often related to the first – if you do CPR when it’s not needed, or you do something wrong, are you going to find yourself getting sued by the family or getting into other legal trouble? We’ve all heard the internet tales of people getting sued for trying to help.

Many countries (including Australia, the US, China and India), have something called “Good Samaritan” laws. Named after a story from the Bible about a stranger who helped a wounded man, these laws prevent people who are stepping in to save lives, or help the sick and wounded, from legal backlash if things go wrong – or just don’t end well. There are a few situations where the laws don’t apply (such as if you’re actually responsible for the person’s condition), but for the most part, they mean that as long as you’re genuinely trying to help someone, you can’t get arrested or sued for doing so.

Some countries and regions – including much of Europe and South America – even have “Duty to Help” laws, which require bystanders to help in a medical emergency if they’re able. Under such laws, failing to render assistance can make you legally liable.

Many people are not trained in CPR

Despite how valuable a skill CPR is, many people don’t know how to use it. For example, in Australia, only one person in twenty has been formally trained in CPR or first aid. Millions of people suffer cardiac arrests each year, none of which survive without CPR or defibrillation. In fact, cardiac arrest is sometimes also referred to as “Clinical Death”.

Some of those occur with no one else around, but many occur either in the home with family present or in a public space. With better knowledge of CPR, hundreds of thousands of lives could be saved every year. CPR training takes only a few hours and costs less than a tank of petrol nowadays. It’s also widely available, with training centres and organisations available in most major cities and population centres – from New York to Caboolture. There’s never been a better time to get trained!

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