What Is CPR?

CPR is an acronym for cardiopulmonary resuscitation. According to MedlinePlus, it may include:

• Rescue breathing (to deliver oxygen to your lungs)*
• Chest compressions to pump blood from your heart to the rest of your body
• A breathing tube to keep the airway open
• Medications delivered intravenously, into a bone or directly into the heart
• Electric shocks to restore heart rhythm

*Note: In 2010, CPR guidelines for untrained laypersons were updated to indicate that compressions alone (without rescue breathing) could circulate the remaining oxygen in the bloodstream of a victim of sudden cardiac arrest. However, trained laypeople and healthcare providers will always initiate both rescue breathing and chest compressions for a person with no pulse.

CPR is a highly invasive procedure, and offers differing levels of success. Despite public perception, patients who suffer sudden cardiac arrest in the community (for example, at home or at work) have an overall survival rate of just over 10%, and only 8.3% survive with neurological function intact. Patients who experience cardiac arrest in a hospital setting fare somewhat better, with an overall survival rate of just under 25%. 

But overall survival rates can be very deceiving. For example, a 2014 study reported in Age and Ageing found that nearly 40% of elderly patients who received CPR in a hospital setting initially survived. (In other words, their hearts started beating again.) But more than half of those patients later died in the hospital without ever returning home. What’s more, a person’s chance of leaving the hospital after “successful” CPR decreased with age. Between the ages of 70 and 79, a person’s chance of being discharged was nearly 19%. This fell to 11% in patients who were 90 years old or older. 

Furthermore, even properly performed CPR can cause serious harm, the American Heart Association notes. Chest compressions may cause rib fractures and fractures of the sternum (the flat bone in the center of the chest). It may also lead to pneumothorax (free air in the chest cavity), hemothorax (bleeding in the chest cavity), bruising of lung tissue and lacerations of the liver and spleen. Fat emboli (particles of fat in the bloodstream that may lodge in the lungs, brain or heart) can also occur. What’s more, emergency protocols dictate that once CPR is started, providers must continue until a heartbeat is re-established or the person is obviously dead. Depending on the circumstances and setting, this can lead to prolonged efforts that some physicians liken to physical abuse.

Sources

“Do-not-resuscitate order”. MedlinePlus. https://medlineplus.gov/ency/patientinstructions/000473.htm 

“What Is Cardiac Arrest?”. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/cardiac-arrest 

“AHA Releases 2015 Heart and Stroke Statistics”. Sudden Cardiac Arrest Foundation. https://www.sca-aware.org/sca-news/aha-releases-2015-heart-and-stroke-statistics 

“The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review”. Age and Ageing. https://academic.oup.com/ageing/article-abstract/43/4/456/2812217?redirectedFrom=fulltext

“Part 3: Adult Basic Life Support”. AHA Journals. https://www.ahajournals.org/doi/full/10.1161/circ.102.suppl_1.i-22 

“The Hidden Harms of CPR”. The New Yorker. https://www.newyorker.com/news/the-weekend-essay/the-hidden-harms-of-cpr