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Tuesday, February 28, 2012

CPR and Heroic Measures: Are They Worth It?

We've all seen it on TV: Joe keels over grasping his chest, or the car with little Suzy smashes into a tree, or Uncle Bob is found slumped over his kitchen table.

A hero rushes up and administers CPR saving the person's life.

But how real is this?

According to this Science Blog article "77 percent of TV patients survived immediately after the cardiac arrest, and 67 percent appeared to enjoy long-term survival. Among actual patients, survival ranges from 2 percent to 30 percent for out-of-hospital cardiac arrests and 6.5 percent to 15 percent for in-hospital arrests."

At worst at 2% chance, at best a 30% chance - reduced to 15% if you're in a hospital.

Yet TV reports a 60% - 77% success rate...

This made me think about the AED devices I see hanging around everywhere.  Automated Electronic Defibrillators.  Three... Two... One... Clear - ZZZZZAP! And grandma or little Johnny come back to life.

Now I wondered "how would you know when to use an AED?"

Not being a doctor I really wouldn't have any idea when someone's heart was in defibrillation.  A quick check of Wikipedia shows that the AED's know when to apply themselves - I suppose the internal computer checks the electrical signals from the heart and, if it detects common forms of heart arrhythmias jolts the patient.

Though I think it would be something of a "tough call" to rip open the shirt of someone's who's collapsed and slap on the paddles.  What if they had choked?  The AED wouldn't do much good. 

Apparently neither would CPR.

I looked around for some statistics on the success of AEDs but I could not find anything other than a variety of anecdotal stories where the devices "saved someone's life."  You would think that if there were stats on this they would be trumpeted to the high heavens by the manufactures.  But since there aren't any out there to find, at least on Google, my guess is that there really aren't any (yet?)...

This leads to other conundrums as well: do I use CPR or the AED?  Which one first? 

Will the "patient" sue me? 

The real question, I think, is what would professionals do?

In this case medical professionals. 

So take a look at this WSJ article "Why Doctors Die Differently."  The upshot here is that in a 2003 study, compared to about 20% of us non-medical professionals, 64% of doctors take steps "specifying what steps should and should not be taken to save their lives should they become incapacitated" (bolding mine).

That's right - those who work in the field don't want medical magic applied to "save them" from dying.

I wonder why?

For one thing having some control over your own death offers a sense of closure for you and your family.  No one has to stand around in a hospital room wringing their hands every day.  You can do things that are important to you - spend time with family and love ones.  And so on.

Doctors, more than likely, understand that most "lifesaving" care is ultimately futile - especially in the "long run" which might be a few extra months or a year - and particularly if you are left with a diminished capacity during that time.

The WSJ article describes a few anecdotal stories where somebody, upon discovering they are doomed, simply go home and enjoy the remainder of their lives.


More interesting is that the "cost" of this kind of death, at least according to the WSJ article, is often ridiculously low: say $20 dollars of pills a month.

Yet TV and big pharma don't see much interest in pushing this kind of death.

I wonder why not?

Perhaps they don't make as much money from it...?

One medical study that I have never seen or heard of - and I suspect I never will - is this one:  What will it cost to die if I am first "saved" by medicine.

Let's say I am a smoker - so there is an increased chance I would die of heart disease - bang - one day I simply fall over dead with a heart attack.  Total cost: an ambulance ride to the ER where I am pronounced DOA - a few grand and off to the funeral home.

Now let's say we could somehow estimate the cost of both A) the fact that I survived the heart attack - what would the "cost" of keeping me alive be and B) what if I recover 100% but die of Alzheimer's after 10 years of wasting away.

Did society really "save money" by having me quit smoking?

Was my life really better off "dropping over dead" or lingering in misery for 10 years?

My mom is in her eighties.  She still holds the depression-era "doctors are gods" model in her mind.  So anytime she has a problem her first choice is to call one or run to the hospital.

Over the last seven or eight years since my father became ill and passed away (Alzheimer's) I have worked hard to convince her that once the "medical system" gets hold of her she is doomed.  I have heard too many stories about aged parents, friends and relatives who enter the hospital for seemingly minor issues only to be pronounced dead a few weeks later having never left.

Mom's been in relatively good health (not that she would agree) and only been in the hospital once in that time for a couple of days.  I work hard to keep her out because I know that once they get her the same will happen to her.

Mom still drives and gets around on her own and her only medication is a blood pressure pill.

Not bad for someone in her eighties.

A while back she was in the hospital for a gastrointestinal problem for a couple of days.

I think she saw the writing on the wall and realized this was not a "safe" place to be.  I think it was kind of an epiphany for her because before this running to the hospital was top on her list.  I am not sure exactly what happened but in the end I think she saw that her interests were not the primary interests of the hospital and that, ultimately, she would lose control of her own destiny there.

Heady stuff for someone with her background and predisposition for seeking medical care as a first choice.

Medical treatment today, I think, is only about control and money - and its getting worse.

But TV and popular culture display a far different picture than reality - and even those professionals making a living at it don't seem to really trust it.

I've come to believe that these days its so bad that even my mom, who came from an era where doctors where the ultimate, now sees it all for what it is.

A shame.

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