WHEN CPR DOES NO GOOD

In newly revised guidelines for administering cardiopulmonary resuscitation, the American Heart Association endeavors to simplify the steps in CPR. The AHA advises that hard and fast chest presses should come first, before mouth-to-mouth. What used to be ABC (airway, breathing, compressions) has become CAB.

The new guidelines advise that the rescuer push deeper into the chest -- at least two inches in adults. I suspect that’s a more significant push than many would be comfortable administering, and I can imagine a rescuer, whether trained or untrained, sensing having crossed a line between therapy and violence. Two-inch pushes at 100 per minute are going to leave bruising.

For me, this begins to address the seriousness of CPR as a medical procedure, and the distinction among types of CPR, which had seemed such a reasonable, heroic and nonviolent attempt to get anyone whose heart had stopped back to normal. Clearly I watched too much TV.

Two years ago, when I joined, the Community Ethics Committee was near completion of its report on non-therapeutic CPR -- that is, CPR performed in a hospital, by trained staff, on a patient who will derive no benefit from it, and is in fact very likely dying. The medical staff know this, and advise against CPR, but the patient’s family wants “something” done.

There is a reality to cardiac arrest -- it’s involved in 100 percent of deaths. And though CPR can be a lifesaver, it is not routinely effective. Meanwhile, the medical community is increasingly concerned about providing the intrusive and violent procedure at the point when patients are in the process of dying -- when CPR may only serve to prolong suffering, delay the inevitable, and destroy the possibility of a death with dignity.

That is definitely NOT the CPR mythologized so dramatically and heroically on TV hospital dramas.