Is the portrayal of CPR on tv/in movies totally inaccurate?

October 23, 2007 9:35 AM

Is the portrayal of CPR in tv/movies totally bunk? I read somewhere that CPR can't actually return someone to consciousness, but rather just keeps them alive long enough to receive more advanced medical treatment. Is this actually the case, or could CPR alone revive someone?

I've been rewatching Lost lately (with my gf who's never seen the first 3 seasons) and was reminded of something I read about CPR. I don't remember where it was, but the claim was basically that the portrayal of CPR on tv/in movies is dead wrong. Whatever this was said that CPR can't ever actually return someone to consciousness, but rather it merely serves to keep the unconscious' heart/lungs moving enough oxygenated blood to keep the brain from dying. This won't bring someone back to consciousness, but it will keep them alive until the paramedics arrive.

So, if that's correct, whenever someone on the island has been shot, strangled, nearly drowned, etc. and Jack brings them back with CPR, that's basically impossible. I realize that tv/film isn't a bastion of realism, but is that really the case? Is CPR useless unless more sophisticated medical care (crash cart or whatever) is available? Could CPR alone return an unconscious person to consciousness?

posted by Nelsormensch to health & fitness (17 comments total)

I just took my CPR renewal. Instructor said that if someone stopped breathing, but the heart was still beating, then the breathing part of CPR could bring someone back (ala "rescue breathing" for lifeguards). But if someone's heart stopped, then the CPR just keeps the person going with the least brain damage (oxygen & blood circulating) until the EMTs come with drugs and defibrillator. So, she said, you have to call for help before you start CPR (unless child, in which case one cycle then call) because otherwise you'll be doing CPR for hours which is no good.
posted by ClaudiaCenter at 9:40 AM on October 23, 2007

ClaudiaCenter has it. (Or so I learned in my First Responder training course.)
posted by JMOZ at 9:49 AM on October 23, 2007

That's basically true, though some would suggest that an adequate amount of mechanical force to the chest (beyond the compressions in CPR) could potentially kickstart a heart. This (known as precordial thump) used to be part of the algorithm used by professionals (ACLS - Advanced Cardiac Life Support) but has fallen out of favor and subsequently been removed for a variety of reasons. What really restarts a heart in a ventricular rhythm is defibrillation.

But lest you forget, the island is a special place with special people and our rules may not apply over there.
posted by drpynchon at 10:03 AM on October 23, 2007

TV Tropes: CPR = Clean Pretty Reliable
posted by smackfu at 10:13 AM on October 23, 2007

This is one of those "it depends" questions where explaining why "it depends" would take up half a page.

But to answer the question shorty, yes, it can bring a person back to full consciousness like in an episode of "Lost" but it won't in the majority of the situations a person will encounter because respiration and circulation are very basic operations of the body that don't stop unless something is preventing them operating.
posted by 517 at 10:22 AM on October 23, 2007

This question reminded me of two awesome papers:

As seen on TV: observational study of cardiopulmonary resuscitation in British television medical dramas

and

Cardiopulmonary Resuscitation on Television — Miracles and Misinformation

They have rather conflicting results. However CPR in the community is very rarely successful, and most people do need immediate ITU/ICU care if they are resuscitated.
posted by roofus at 10:24 AM on October 23, 2007 [1 favorite has favorites]

There's "can" and "possible" and there's "likely." Like Claudia, I just had my renewal (Thursday even). My instructor's phrasing was "you're likely not going to save someone's life with CPR. You may very well keep them alive long enough for them to get medical attention which will save their life.

That's kind of a funky (and not very generous!) definition of what it means to save a life, but what she means is that it's unlikely that CPR by itself is unlikely to bring that person back to being up and around. In almost all cases you're buying time till the paramedics show up.

This was my first CPR class that included discussion (and training) about the use of IEDs. I had not been aware that their functioning is limited exclusively to people where there IS an existing - but irregular - heart rhythm. I'd always assumed they operated in a manner similar to a full defibrillator. My instructor indicated that if you were performing CPR and attached a IED the odds were that it would recommend against (and not allow you to apply) shocking the heart.

So basically, what 517 said but about 1000 times as longwinded. Sorry.
posted by phearlez at 10:31 AM on October 23, 2007

In over 20 years as an emergency responder, I never saw anyone revived by CPR alone, regardless of the situation. In the few cases where the person's heart began beating again it was because they were shocked out of ventricular fibrillation by advanced EMTs. None of them regained consciousness. When I used to teach CPR back in the 80s, this was one of the things we discussed. We wanted to dispel any misconceptions but not discourage them too much.

The good news is that automatic defibrillators are becoming common and can be used by practically anyone. CPR is still important, though, it's just not like the movies.
posted by tommasz at 10:37 AM on October 23, 2007

A quick google turns up this AHA webpage with these stats:

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.

I wonder what the conclusion, if any, there is to reach from the impact of EMS response time. Is the CPR having a big impact on people's odds of recussitation or is it simply preventing brain damage when they are stabilized by other non-layman means?

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 victiims receive bystander CPR and time to EMS response and defibrillation is longer, survival from sudden VF cardiac arrest averages 1–2 percent.

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.

Every stat talks about EMS. I'd say your thesis is accurate: in almost no case will CPR result in someone getting back up in the short term.
posted by phearlez at 10:41 AM on October 23, 2007 [1 favorite has favorites]

I also read that most people can't keep up effective CPR for more than about two minutes (it's hard work!), so unless you find someone to help out before you start, the person is still likely to be dead before the ambulance arrives.
posted by emilyw at 10:52 AM on October 23, 2007

some would suggest that an adequate amount of mechanical force to the chest (beyond the compressions in CPR) could potentially kickstart a heart. This (known as precordial thump)

This must be what Jack did [Mid-season one spoiler!] to Charlie that time after he was hanged. Remember, he was just banging on his chest really hard and he revived? I always thought that was way out there...like if you don't have a defibrillator, you just start hitting them?

But yeah, with LOST, they've given themselves a lot of wiggle-room for medical stuff by establishing the island as a place with healing powers. So anything at all medically possible is that much more likely to work there.
posted by lampoil at 10:58 AM on October 23, 2007

Hopefully not too far afield, since we're discussing CPR in real life and the movies/tv...

When I took my first CPR class back in the mid/late 80s they were phasing out the cardiac thump, what lampoil describes from Lost. CPR has changed over the years and will likely continue to change.

During my first class they mentioned the thump but commented they discouraged it. People were getting enthusiastic and going wild and accomplishing nothing.

My first CPR class taught us to pair off if someone else knew CPR with one person doing 5 compressions followed by the other providing one breath. If you were alone it was 15 compressions and three breaths. We were told to find the bottom of the breastbone with one hand and do our compressions 2 fingers up from that.

Almost 20 years later they taught us to do 30 compressions and 2 breaths with no mention at all of any "buddy" work. We were told to draw an invisible line between the nipples and place our hands there to do compressions.
posted by phearlez at 1:05 PM on October 23, 2007

We were taught the 30-2 combination this time for all ages (last time I had the training the numbers varied depending upon the age). Like you, the instructor mentioned that the breathing aspect is considered less important now, and that they may decrease the two breaths even further.
posted by ClaudiaCenter at 3:18 PM on October 23, 2007

Twenty years ago when I was an EMT, I saved only one person using CPR (well sorta, he died a day later from another heart attack in the hospital). It does help, but yeah, its really more maintenance until the proper help arrives. Doesnt mean everyone shouldnt learn it. Hey it can be all the difference. No joke.
posted by elendil71 at 3:55 PM on October 23, 2007

The other thing that I was taught in my CPR class was that the act of compression breaks the cartilage in the chest that holds the ribs together with a very loud cruuunch. That's obviously something that would never be done on TV...
posted by Arthur Dent at 10:34 PM on October 23, 2007

My little sister saved a girl from drowning by doing CPR on her. I didn't have as much success when I did CPR on my dad.

It's hard work, mentally and physically repellent, and almost made me hyperventilate and throw up.

People don't warn you about that - you expect it to be all "I'm doing something worthy, and saving someone's life" but it felt like I was being forced to make-out with my father, and was the most traumatic experience of my life.

I was 14 at the time, the same age as my sister was when she saved the girls life. She is also pretty traumatised about the experience, and refuses to talk about it.

Depictions of CPR that really bother me are that 99% of the time it magically works. It makes me feel inadequate, although, with an ascending aortic aneurysms there was absolutely nothing I could do.
posted by jonathanstrange at 3:12 AM on October 24, 2007

On TV and in movies, the person giving CPR never *ever* does the head-tilt chin-lift first, which opens the airway and lets the air get into the lungs. Without that move, any air you're blowing into the mouth is useless. So yes, I'd say the portrayal of CPR on tv/in movies is totally inaccurate on that count alone.
posted by mediareport at 12:23 AM on November 1, 2007