CPR & PUBLIC PERCEPTION

Is it better to do something than nothing? Always?

The Boston Globe has published an exceptional piece on contemporary thinking about CPR by correspondent Karen Weintraub (see http://www.boston.com/yourtown/quincy/articles/2010/11/01/health_officials_say_paring_down_cpr_to_just_chest_compression_could_save_more_lives/).

In explaining giving new priority to chest compressions as the most effective method for non-medical personnel, the story clearly puts the practice of cardiopulmonary resuscitation into perspective. Weintraub underlines the important fact that while CPR can be a life-saving measure for individuals in cardiac arrest, it fails to revive the person more often than TV dramas would have you believe. The story also notes that the untrained bystander often must overcome squeamishness to perform CPR on a stranger, and that there’s less to overcome with chest compressions than with mouth-to-mouth.

And yet the story also perpetuates an assumption about the benefits of CPR that can have profound ramifications in the emergency room. A cardiac expert says of the American Heart Association’s new policy that “we hope that more people will at least do CPR, which will at least keep some blood flowing. It’s better to do something than nothing.”

Is it true that it’s better to do something than nothing? For the bystander suddenly confronted with a collapsed individual, it probably is true. But something significant is lost in the public’s understanding of CPR when its practice moves from the innocent bystander to the emergency room, where bones get broken, bodies get shocked, and medical personnel can be left to feel they’ve inflicted pointless violence on a dying individual -- for the benefit not of the patient, but of the family. Doctors and nurses can see irreversible dying in progress, rendering CPR of no therapeutic value. And yet, they are asked to “do something,” and though doing otherwise can seem heartless, acting against their own judgment about what’s best for the patient can have psychic consequences for medical personnel that carry over to the next patient.

Even if only one life in ten might be saved, it’s easy to support public education in the basics of CPR. But maybe, sometimes, doing something means withholding non-therapeutic CPR.