Sudden Death and the Myth of CPR

Anyone who has ever taken a CPR course has wondered, "What would happen if I actually had to use CPR?" In Western societies, the lifesaving power of resuscitation has the status of a revered cultural myth. It promises life in the face of sudden death, but the reality is that lives are rarely saved. Medical researchers estimate the survival rate for out-of-hospital CPR to be between 1 and 3 percent. Sudden Death and the Myth of CPR explores the history of this medical innovation and the promotion of its effectiveness.

The overuse of resuscitation, Timmermans explains, defines people's experience with sudden death, something he learned firsthand by following the practice of lifesaving from street corner to emergency room. He argues that very few people are successfully resuscitated without brain damage despite the promotion of CPR's effectiveness through powerful media images. In vivid accounts of the day-to-day practices of cardiopulmonary resuscitation in one of the only studies of sudden death, Timmermans records the astonishingly frank comments of emergency personnel. Doctors, nurses, social workers, and paramedics express emotions from cynicism about going through the futile motions to genuine concern for victims' family members.

If a person who was supposed to keep on living dies at the end of a resuscitative attempt, how socially meaningful is the dying? Timmermans asks tough questions and addresses the controversial ethical issues about the appropriateness of interfering with life and death. He suggests policy reforms and the restoration of dignity to sudden death.

While these examples seem small, the inaccuracies can seriously damage the author's credibility. Using the above examples, here's why:
1) The paddles DID NOT weigh fifteen pounds! The doctor needed to APPLY 15 POUNDS OF PRESSURE to the dogs chest to activate a safety switch. This is what caused the blood pressure to suddenly peak in the dog. We still apply several pounds of pressure to defibrillator paddles today; if the author had read a advanced cardiac resuscitation book he would learn of this.
2)Angina is the wrong word. Angina, or "heart pain" has nothing to do with the situation. Rather, the word should be "agonal" which means "dying".
3)When the nurse here says "60", she is not referring to the heart rate, but blood pressure. (We know this by reading the next line.) There is a big difference between the two, and the difference has clinical significance. (Traditionally, a carotid [neck] pulse, which is mentioned in the next line, indicates that the blood pressure is at least 60mmg.)

The book comes to some very strange conclusions ("Mouth to mouth remains an unarousing sexual act" Page 93) and some vivid and imaginative descriptions of CPR. ("CPR is unusual in the way it brings strangers into intimate contact. First the rescuer "kisses" the unconscious person, then "hits" the person hard. We love life, hate death, love life, hate death in a perpetual rhythm." Page 93)

This is obviously a well-intentioned book, but I feel disappointed in the many mistakes, strange conclusions and unrealistic suggestions. (The author suggests that everyone should carry some form of ID that states whether or not they want CPR done to them. Not only would this be a logistical nightmare, what happens if the card isn't with the person? Will rescuers fear helping people just because they don't have a card? Terrible and frightening idea!)

This is a more of a "thinking" book...it gets you thinking. But if one believes that the book shows all the sides of resuscitation, they are wrong...
February 17, 2002

Please! Dignity is for bystanders who don't want their sensibilities upset, not for the guy on the stretcher. I know. I was that guy. I may hold the world record for being revived. During a massive heart attack, I was defibrillated 72 times. It took almost three hours of work to bring me back. And guess what? I wasn't the slightest bit concerned with dignity. I just wanted them to keep working until they got me back.

Did I care if my chest was fried from the voltage? No.

Did I care that they stripped me and half a dozen people were handling me? No.

All I cared about was getting back so I could see my wife and I didn't give a tinker's damn what they did to me. Now, it's five years later and I am healthy.

Yes, only a fraction of people who arrest survive resuscitation. But some do. Resuscitation, by definition, is a last-ditch, desperate measure. Admittedly, most victims won't make it. But that's not why we do it. We do it for the ones who DO make it....
December 31, 2000