Map of life expectancy at birth from Global Education Project.

Thursday, January 27, 2011

The CPR-Charitable Complex?

I have never gotten around to taking CPR training but I've run into a lot of people who are quite -- well, sanctimonious is kind of a disparaging term, but let's just say they are big promoters of how getting CPR certified is a requirement of responsible citizenship.

This essay in NEJM by Dr. Gust H. Bardy is a bit difficult to follow in the beginning for a non-specialist, but basically what he is saying is that, while shocking the heart is effective in cases of cardiac arrest, there is actually no evidence that CPR -- compressing the chest to the beat of Stayin' Alive -- does any good whatsoever. People who have been trained in CPR are also trained to call 911 right away, and to the extent that CPR looks like it helps, that might be the only reason.

And, it turns out, organizations such as the American Heart Association and the Red Cross make a lot of money by giving CPR training. There is a very large vested interest in maintaining the belief that CPR saves lives, but Dr. Bardy has me pretty well convinced that we may be fooling ourselves. He argues that because we don't have evidence of the value of CPR, it would be ethical to design a clinical trial in which it is randomly withheld, although I can't see offhand how that could be achieved logistically.

In any case, the bottom line is that if someone goes into cardiac arrest, it is still highly unlikely that the person will survive if they receive only prompt CPR and do not quickly receive external defibrillation. First call 911! Seconds count! Putting more automatic external defibrillators in public places, and perhaps the homes of people at risk, can definitely help. But we shouldn't think of CPR be a substitute, says Dr. Bardy.

Please! I'm not saying don't do it! It's the standard right now and maybe it does work. But we really don't know.

No comments: