CPR: Risk Outweigh Benefits in Older Patients?


ORLANDO, Fla. (Ivanhoe Newswire) — Push down hard and fast at a rate of 100 to 120 pushes per minute. Time the pushes to the beat of Stayin’ Alive and continue until medical personnel arrive. This is how you give hand to hand CPR, and though it has saved lives, should it be used in every scenario? What are the risk?

Cardiac arrest kills someone every two minutes.

“It accounts for about 390,000 deaths in the United States each year,” stated Robert J. Myerburg, MD, University of Miami Miller School of Medicine.

At least 70 percent of all cardiac arrests occur outside hospitals and seem to come out of nowhere.

“Fifty percent of sudden cardiac deaths are first cardiac events meaning the patient did not know they had heart disease,” said Dr. Myerburg.

But nearly 45 percent of all those who were saved out of the hospital, were saved by someone who immediately started CPR. According to Swedish researchers, the 30-day survival rate after a cardiac arrest is under seven percent for patients past their seventies.

There is also the risk of broken bones, a sore chest or lung collapse. A survey of 600 clinicians found that more than half said giving CPR even if only two percent survive is still appropriate. Not all doctors or patients agree. So, if you’re older than 65, discuss this with your family in advance. Generally, do not resuscitate orders only apply in the hospital. Protecting loved ones if they want you to.

Older adults can make their wishes known if they do not wish to be saved. There are do not resuscitate policies that have been adopted by states. There are different names by state such as ‘MOST’, Medical Order for Scope of Treatment in states or ‘POLST’, Physician Orders for Life Sustaining Treatment.

Contributors to this news report include: Julie Marks, Field Producer; and Roque Correa, Editor.


REPORT #2738

BACKGROUND: Every year, 475,000 people die from cardiac arrest in the United States. During cardiac arrest, the heart cannot pump blood to the rest of the body, including the brain and lungs, and death can happen in minutes without treatment. Cardiopulmonary Resuscitation (CPR) is an emergency lifesaving procedure performed when the heart stops beating. It uses chest compressions to mimic how the heart pumps and helps keep blood flowing throughout the body. About 9 in 10 people who have cardiac arrest outside the hospital die. However, if CPR is performed in the first few minutes, it can double or triple a person’s chance of survival. Cardiac arrest is not the same as a heart attack. A heart attack happens when blood flow to the heart is blocked. A person having a heart attack is still talking and breathing, therefore does not need CPR. However, heart attack increases the risk for going into cardiac arrest.

(Source: https://cpr.heart.org/en/resources/what-is-cpr and https://www.cdc.gov/features/learn-cpr/index.html)

CPR AND OLDER PATIENTS: CPR involves chest compressions at least two inches deep and 100 times per minute. Sometimes, air is forced into the lungs and an electric shock is then sent to the heart in attempts to make it beat again. But, CPR can cause major trauma including fractures to the rib, sternum and spine; damage to the liver and spleen; damaged airways; internal bleeding; or heart contusions and pulmonary complications. Studies involving a total of 417,190 patients ages 70 and older were reviewed for the survival rates of patients undergoing in-hospital CPR. They found about 40 percent of the patients had successful CPR, but more than half of those patients ultimately died in the hospital. For patients ages 70 to 79, the rate of survival until discharged was about 19 percent. Those between ages 80 to 89, the rate was 15 percent.

(Source: https://www.lifemattersmedia.org/2016/08/cpr-versus-dnr-elderly-patient/)

NEW WAYS TO IMPROVE CPR: A study led by Sue Duval, PhD, Associate Professor of Medicine and Biostatistics at the University of Minnesota Medical School, and assisted by an international team of resuscitation investigators, suggest the combination of 107 compressions per minute with a depth of 4.7 cm (about 2 inches) in the first five minutes of CPR, can be associated with significantly improved outcomes when EMS rescuers are treating cardiac arrest outside the hospital. The combination identified did not seem to significantly vary when analyzed according to age, sex, presenting cardiac rhythm or the use of a specialized device attached to the airway during CPR. In fact, the use of the device significantly improved outcomes when the target combination of rate and depth was utilized. “The findings here not only emphasize the importance of quality CPR performance, but they will likely help paramedics and others on the frontlines save many more lives,” said Paul Pepe, MD, Professor of Emergency Medicine at UT Southwestern.

(Source: https://www.sciencedaily.com/releases/2019/09/190918121204.htm)

* For More Information, Contact:

Robert J. Myerburg, MD


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