Writes Sunita Puri in "The Hidden Harms of CPR The brutal procedure can save lives, but only in particular cases. Why has it become a default treatment?" (The New Yorker).
"In 1792, the British physician James Curry distinguished between 'recoverable' deaths, which were caused mostly by accidents, and 'absolute' deaths, which were the result of chronic illness or debility. Resuscitation was meant for the former—as was CPR, which was officially introduced in 1960. That year, William Kouwenhoven, the inventor of the defibrillator, published a paper that studied the effect of the procedure on twenty patients in cardiac arrest. Seventy per cent of them survived—a rate that is unheard of today. That’s because the patients were young, otherwise healthy people whose hearts stopped for treatable reasons: electrocution or the side effects of surgery or anesthesia...."
Posts
49 comments:
Probably has something to do with nicotine if it's tobacco smoke. So it's not totally crazy...
I'm going to add a clause to my DNR stating expressly that the sole exception to not reviving me is if pumping tobacco smoke into my anus with a bellows will get the job done. Otherwise, DNR.
Medical science then and now sees us all as body parts rather than integrated humans. Add something, take something away, and violate an orifice or two for good measure.
What the fuck kind of bad journalism says
"The first known revival of a dead person took place on December 3, 1732."
you morons
I hope you're not a Christian because that's an embarrassing damn sentence.
The focus here is on CPR but the story disturbingly omits Hypothermia has long been recognized as slowing down the needs of the body such that a lack of oxygen for relatively long periods of time become survivable, yes? Does the story ever mention that?…and the big problem with intubation and the ventilators is infection, yes?
Crap…
You can debate what the word "known" means
but Lazarus was declared dead
and was buried
plenty of witnesses saw what happened next
why should we believe you skeptical fucks in the media?
come on, New Yorker, haven't you heard of the Bible?
Forgive me for not having a NYT subscription, but while CPR is brutal and might crack a rib, if you're not breathing, isn't the alternative death? And if it doesn't work, then why would a dead person care they had a cracked rib?
"The brutal procedure can save lives, but only in particular cases. Why has it become a default treatment?"
I am torn by a conundrum, is Sunita Puri too silly or too iniquitous for words? The why of resuscitation is glaringly obvious, so why clutter the public mind with such verbiage? And yes, resuscitation can be brutal. Broken bones, punctured lungs, abraided esophagi, and even third-degree burns can be complications of CPR. But what medical procedure isn't brutal? Surgery under the knife isn't completely different from a mauling by the talons of a Bengal tiger, but the results are generally more favorable to the person brutalized by a surgeon than one brutalized by a big cat, though "gender affirmative" surgery, assuming the act merits the label, is worse than a mauling. At least the cat gets a meal out of it. Has Miss Puri considered the alternative to CPR? If not, she's too silly to be published in a respectable magazine, else she's too wicked.
The article says it only works 15% of the time and often these are people who are close to death anyway, so in many cases, analyzed individually, it might be better to allow the person to go.
It takes issue with CPR as the default.
cassandra lite said...
"I'm going to add a clause to my DNR stating expressly that the sole exception to not reviving me is if pumping tobacco smoke into my anus with a bellows by an attractive Practitioner of the Medical Arts will get the job done."
You left out the bolded part.
Birches says: Forgive me for not having a NYT subscription . . . “
You can click on the link - it’s in the New Yorker so you’ll be able to read the article.
death panels in ambulances now
"let's just let him go"
Hippocratic Oath out the window
I am Pro-Life!
Saint Croix said...
"What the fuck kind of bad journalism says: 'The first known revival of a dead person took place on December 3, 1732.'"
Yeah, but that wasn't done by a certified medical professional with a License to Practice Resurrection issued by the local Judean authorities, so it doesn't "count".
And just to piss off the Sanhedrin, he did it again over Passover weekend.
My wife, who has performed CPR many times in her life, talks about this often. It is brutal and the patient is very likely to have bruised or broken ribs, if they survive. The older are more likely to get broken ribs. And, the hospital is very capable of keeping people alive for a much longer time than say another environment where CPR might revive a person but not sustain the life. It is difficult for younger people to understand, but it can be kind to let someone succumb to their illness without the brutality of CPR.
It is also an effective life saving technique when used on a person whose body was not already on the brink of death.
Dylan Thomas said...
"...Do not go gentle into that good night..." and "...rage against the dying of the light..."
The article has a wiff of Euthanasia Approval about it: Who cares if the old person dies as long as it is peaceful?
I practiced Emergency Medicine for 40yrs and participated in CPR a few thousand (I would imagine) times. The yield of those attempts in "saves" - restoration of sustained cardiac electrical activity, with or without unaided cardiac blood pumping activity - was minuscule. Furthermore, my recollection is that I was only aware of one single such patient who left the hospital alive.
Sure, we all knew that what we were doing was near-worthless. "Near" being the key word there. But what were we to do, stand there and watch them die - when one of them might end up being that guy who would walk out of the hospital a week later? That was, and is, never going to happen.
"The article says it only works 15% of the time and often these are people who are close to death anyway..."
Forgive me, but performing CPR on someone not close to death is both useless and deleterious to health and well-being. Have we blundered into the Ministry of Silly Walks by any chance? If so, I have this knees-bent advancing behavior that could well use a generous development grant.
Yes, Jesus was first.
"The latter method is the origin of the phrase 'blowing smoke up your ass.'"
Talk about blowing smoke up someone's ass. I'd bet money that procedure is not the origin of the phrase.
Why default to CPR? It demonstrates all reasonable measures were taken to preserve the life of the patient. Otherwise, lawsuits follow the death.
The article says it only works 15% of the time and often these are people who are close to death anyway, so in many cases, analyzed individually, it might be better to allow the person to go.
Okay, Althouse, no CPR for you if you stop breathing. Tough luck for your commentariat if you would have been in the 15%. (Not to mention tough luck for you!)
It takes issue with CPR as the default.
It takes issue with making any attempt to save the life, CPR is just the usual attempt.
My wife was a firefighter/EMT. She says that CPR was minimally effective- if the ambulance doesn’t show up quickly the victim has little chance of survival. She did call me excitedly once because “We got a save!” Once in twenty years…
I wish TV shows would show basic first aid, like putting pressure on a bleeding wound and lowering the head and raising the legs to keep remaining blood flowing to the brain.
In 2015, my father collapsed from a bleeding duodenal ulcer (caused by ibuprofen), and I got him breathing again with a punch to the chest. A year later, the same ER he'd gone to gave him, for a compression fracture, an NSAID known to cause bleeding ulcers, which it did. Found out what they gave him in January when he was in again for a mild stroke. The first anti-seizure med they gave him made his heart rate drop to 40, so I spent a night shaking him up every few minutes when the alarm went off. We're not going back to that hospital.
I would like to live, ideally, into my nineties as long as I am able to care for myself with minimal help and with minimal daily pain. Now in my sixties, however, I am astonished to realize that I am also at peace with the idea that death will come, maybe at any moment. I've lived long enough to raise my babies to honorable adulthood, and even to see a grandchild. I have done my part; I didn't break the chain; I pray I played my part in God's plan.
So, no to CPR, unless it's something like an immediate short-lived effort during hospitalization. And hell no to survival with significant brain damage--lived through that nightmare when my step-father was revived after a heart attack (at only age 37) and then lingered in a nursing home for almost a year.
"using bellows to force tobacco smoke into the mouth or anus."
First pass I read that as elbows. Got a chuckle.
clinically dead, brain dead (like the writer of this piece)
Oh thanks, I don't know why I saw NYT.
This debate is completely different than what I was expecting. Receiving CPR in a hospital when you're being treated for other problems is completely different than a miner collapsing at work and being saved by CPR. The issue is having a DNR and that seems to be the point of the article. Yeah, we should get one. But also doctors should have some sense. If you break a dying old guy's sternum, maybe you can call it after that. It's up to you. I would think everyone could agree to stop CPR within ten minutes.
In my last CPR course, the instructor really hit hard on the idea that there is no need to worry about doing it wrong, hurting the person, cracking a rib, whatever. His reason? They're dead. You can't make it worse.
As mentioned by a couple of commenters there are a couple of well documented cases from many centuries before the 18th!
This is more of the Collectivist Left’s death cult. Why waste the Collective’s resources on oldies and the ill when they could be used to cure gay men’s STDs so they could get back to humping each other?
When my husband came of age for Medicare I insisted we keep private insurance. He just had a massive widow maker heart attack and I’m pretty sure if they saw Medicare on his entry forms they wouldn’t have gotten him into the cath lab within ten minutes of being in the ER and saved his life. Hospitals do not get very well compensated by socialist insurance schemes. Remember that when deciding whether to dump your employer’s insurance if it is possible to keep it after retirement.
In my last CPR course, the instructor really hit hard on the idea that there is no need to worry about doing it wrong, hurting the person, cracking a rib, whatever. His reason? They're dead. You can't make it worse.
Mine too. Also, I was taught that the purpose of CPR isn't to "save a life" as if the person is going to get up, take up their mat, and walk, so to speak, but to extend the period when they might possibly be revived through the better equipment and methods available in an ambulance or hospital.
The article says it only works 15% of the time
When they changed to just offering chest compressions I figured it was completely useless like go a boil water. That's a much higher percentage than I would expect and reason enough to continue.
CPR is probably the default because it (a) can be performed without being in a hospital, (b) can be learned fairly easily by non-medical personnel and then used immediately when medical personnel are not present, and (c) can be effective. For the non-hospital setting, it is better than nothing.
Whether it makes sense for a hospital, I have no expertise to judge. It is possible that CPR should not be used except as a last resort in that setting as they have better tools that should be used first. I have no idea.
Does the author provide an alternative that would be better? It is one thing to say that CPR has downsides - what doesn't? - but it is another to say that CPR should not be used at all because it has downsides. It is harmful to some patients so it shouldn't be used is not much of an argument when it does save lives. Don't let the perfect get in the way of the good.
Hey Biblical scholars, neither Jesus nor Lazarus was the first. Old Testament.
> M said...
He just had a massive widow maker heart attack and I’m pretty sure if they saw Medicare on his entry forms they wouldn’t have gotten him into the cath lab within ten minutes of being in the ER and saved his life.<
That is simply not true.
Aggressive minimizing of door-to-cath time is the #1 guiding ethic in every ER and everyone strives for it. No one who is tending to your heart attack gives a whit about your insurance card. All they are thinking about is getting your coronary arteries open and saving your life. Take that to the bank.
Althouse writes, "It takes issue with CPR as the default."
Yes, it does, as if there is an ethical alternative. I'm leaning toward iniquitous rather than silly.
My father had successful CPR a number of times in various hospital stays over a number of years.
Never had a problem with ribs etc.
Some medical folks would try to shame me into placing him on DNR.
Actually, there are plenty of stories - Tammuz, Osiris, Satyavan, Bodhidharma...
Oh, but I don't believe in those people.
“This is more of the Collectivist Left’s death cult. Why waste the Collective’s resources on oldies and the ill when they could be used to cure gay men’s STDs so they could get back to humping each other?”
What a stupid comment. There are plenty of rightist commenters here on this thread who have questions about the efficacy of CPR.
@Quaestor (4:18), agree 100% The odds are basically 6:1 against, but you have no way of knowing ahead of time whether the person you are trying to resuscitate is in that 15% or in the 85%. In the absence of anything offering better odds, normal people do what they can.
Oh! I forgot. To the type of people who write for The New Yorker, "normal" translates into "whatever they would do, do the opposite." Does that hold for people who read the drivel they produce?
Ann Althouse said...
"The article says it only works 15% of the time and often these are people who are close to death anyway, so in many cases, analyzed individually, it might be better to allow the person to go."
Broader context, from the article:
"But one morning in January, 2021, Ernesto burned with fever, his chest heaving as though he were once again lifting heavy boxes. At the hospital, he tested positive for covid-19. His oxygen levels plummeted, and he was quickly intubated. Ten days later, his lungs were failing, his face was bloated from litres of intravenous fluid, and his hands and feet had begun to cool. As his chances of survival waned, I arranged to speak with his family about a subject inseparable from death itself: cardiopulmonary resuscitation, or CPR.
For decades, physicians have debated whether CPR should be offered to people who suffer from the final blows of incurable illness, be it heart failure, advanced cancer, or dementia. Although CPR has become synonymous with medical heroism, nearly eighty-five per cent of those who receive it in a hospital die, their last moments marked by pain and chaos. The pandemic only deepened the risks: every chest compression spewed contagious particles into the air, and intubation, which often follows compressions, exposed doctors to virus-laden saliva."
There's a fifteen percent survival rate in a hospital setting, when survival is much less likely than, say, when EMTs are reviving an otherwise healthy person outside of a hospital. The first example in the article was a COVID patient who had already been intubated and was hooked up to IV therapy.
The push for care directives and refusal of heroic lifesaving measures could as easily be laid to economics as to compassionate care. Besides that, relative to COVID, prohibiting use of therapeutics like ivermectin or hydroxychloroquine, which might have kept the patient out of the hospital, is wrongheaded based on what we now know about their effectiveness when administered early in the course of the disease. (Don't make me repeat previous posts showing the reduction in mortality rates for those medications.)
Shorter version: 'at some point, you've lived long enough.'
"You can debate what the word "known" means
but Lazarus was declared dead
and was buried
plenty of witnesses saw what happened next
why should we believe you skeptical fucks in the media?
come on, New Yorker, haven't you heard of the Bible?"
Osiris would like a word with you.
I personally know 2 people who went into cardiac arrest outside of a hospital setting whose lives were saved by prompt CPR. 15% success sure beats 0%.
I was once acquainted with a successful administration of CPR, which would not be out of place in a Hollywood made for TV movie.
I was freshly married, had a brand-new degree in biology and had moved to the Boston area, which is where my wife grew up. The first job I had was as a temp in the quality control group of a company which made, and I think invented, pregnancy test kits. The company had been bought-out by a big NJ OTC drug and personal care company. The feelings between managers from NJ and workers in the Newton MA facility were not all that hostile, but I came to realize that they had been.
I had occasion to explore the facility: The floor I was on was production, quality and some offices, there was a middle floor which was lab space and the bottom floor assembled and packaged devices. The middle floor was a ghost town--beautifully equipped lab space--expensive temperature controlled centrifuges, balances located on thick slabs of marble, but it looked as if everyone stepped out for a meeting and never came back. There were pens sitting on note pads, pipettes with tips in them sitting on bench tops, etc. I asked about it and found out that on the day of the acquisition, all the research staff were told to put down what they were doing and escorted out of the building. The plan (also the reason I was a temp) was to keep production in Newton only until the technology could be duplicated in NJ. What the company had purchased was IP. So, hard feelings toward the new owners.
A few weeks after realizing all of this, our team was on a lunch break and someone I didn't know came by to visit our manager and after words some of us new people asked about her. All I remember about her role in the company is that, like my manager, she was from the parent company, but more salient to this thread, a few weeks after the takeover she'd saved the life of a long-time and well-regarded worker at this site using CPR.
Rocco
awesome comment at 11:48
Ann Althouse said...
The article says it only works 15% of the time and often these are people who are close to death anyway, so in many cases, analyzed individually, it might be better to allow the person to go.
Insert snarky comment here about not trying to save the lives of New Yorker writers
Post a Comment