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Now I'd like to take a moment to talk to you about something that I've had the honor of talking and explaining to not just students who are thinking about this situation occurring, but actually, those rescuers, whether that be professional or even people who were just helping neighbors or strangers, or in certain cases, even their own family members. And that is, why didn't CPR work? Why did I do what I thought to be the right thing and the desired outcome not happen? And I think that's a fair question. It's certainly a question that I believe finds its roots in a misunderstanding of what CPR is. CPR has always been designed to be a time buyer. You see, when we do cardiac compressions, we're actually compressing this hollow organ we call the heart, and its four chambers. And when in cardiac arrest, the heart is in either a fibrillatory state, which means it's wiggling around in a disordered fashion, or it's completely asystolic, meaning it's not contracting at all. And when it works normally, it's beating from top to bottom in an organized fashion with one-way valves. And it works perfectly to circulate oxygenated blood throughout the whole body, very efficiently. But when a person suffers cardiac arrest, regardless of really what disorder is happening with the heart itself, the fact is, the heart is not circulating oxygenated blood, and the body begins to die biologically. As soon as there's no breathing and no pulse, the person is in clinical death. They have already died. But it doesn't mean necessarily that they're going to remain that way. There's the difference between clinical death and biological death. CPR manually, artificially, tries to do its best to compress that hollow organ between the sternum and the spinal column. That's why we try to push it at least 2 to 2.4 inches deep, because we need to maximize that compression to make up for some kind of circulation that isn't occurring normally. But the reality of it is that even when we do picture-perfect CPR, I mean textbook, it's only a small percentage of what the body needs to survive. And therefore CPR has never ever really been equal to what we think of it sometimes to be, and that's artificial life support. We think, well, as long as we do the cardiac compressions, the body is alive. And it isn't that it dies until I stop doing compressions. And that's just not true. The fact of the matter is that CPR compressions are more acting like the brakes on a downhill freight train. The brakes are not going to stop the train from inevitably reaching the bottom of the hill, but they may slow it down a little bit. CPR does not stop the dying process. It simply slows down the biological cell death a little bit, in hopes that when we activate emergency medical services, 911 or call a code, and we bring in electrical therapy, automated external defibrillators or manual defibrillators, advanced life support, oxygenation and drugs, that we can then somehow restore some form of more efficient and effective circulation of oxygenation, to buy even more time so that we can fix the underlying reason that the person went into cardiac arrest in the first place. But the truth and the fact of the matter is that every person who's alive has a day to die. And we don't know when that is. As a licensed paramedic, I've done numerous cardiac arrests on infants, children, and adults. I've treated the very young and I've treated the very old. And some people that should have died survived, and some people that looked like they should have survived died. As a rescuer, all I knew was that it was their day to live unless they proved me wrong. But as far as I was concerned, I'm going to give them the best chance of survival I possibly could until they prove me otherwise. CPR was never meant to save lives directly. I used to joke around that I would write a book one day: "CPR Does Not Save Lives, It Just Keeps People Dead Longer." And people would go, "What? That doesn't make any sense. What are you talking about?" But that's the reality of it. And I think if we would all approach cardio-pulmonary resuscitation with the understanding of the physiology and the cardiophysiology of what CPR is versus what we perceive it to be, we would understand that when a person is in cardiac arrest, and we do our best doing CPR, then the person remains dead, regardless of who they are. We the rescuer did not fail. The person simply remained dead for whatever reason. But that doesn't take away from the fact that you still gave them the best chance of survival if survivability was going to be the outcome. And the one thing we know for sure is that if you do not try to do CPR, it's almost guaranteed, this side of a miracle, that one thing and thing only is for sure, and that is that they're rapidly going to go from clinical death to biological death and remain dead. And I say "remain dead" because it's important to understand, people in cardiac arrest don't die. They just stay the way you found them. When you're asking yourself, "Well then, if CPR isn't all that, when CPR is less than a miracle drug, then is it really worth trying all that hard?" I can tell you that in my street experience, that though I've never had a person complain to me that the CPR or the defibrillation hurt them when they were dead, I have had them come back in with their family and thank us for another holiday with their families. And as a father of six beautiful children, and a husband, I can tell you that if I was in cardiac arrest, there is nothing more beautiful than knowing that my loved ones embraced me, cared for me, risked themselves, and did everything they could to save my life, regardless of the outcome. Now let's talk about strangers, strangers that don't know the patient from anybody, and yet they care enough in the family of humanity to say "I don't know who you are, but you're special to somebody. I'm going to try to save your life." We don't know when a person can no longer hear, when they go unconscious. We don't know at what point of unresponsiveness and unconsciousness a person can no longer sense or hear what's going on around them. There's a lot of research and it's unclear, but we do know that some people in cardiac arrest have come back out of cardiac arrest and they've actually been able to recount some aspects of the cardiac arrest protocol. So they were able to hear certain things from time to time. Could you imagine how beautiful it must be that when either a family member or a stranger tries to save the life of another, that even if that person remains dead, that there's a chance that their last impression, their last experience, was that of love, that someone would care enough to put themselves out there, outside their comfort zone, run the risk of failure, for the sake of a chance to help you survive. That is the greatest gift that one human being can give to another. So failure is not in whether a person survives cardiac arrest or not. Failure is in whether or not we can understand that just trying is the success. If this has happened to you, I hope that this has brought some peace and clarity and healing to your life. And if you haven't had this happen, my hope is that it prevents you from falling into the category of those people I hold so dearly that have reached out to me that are dealing with pain, agony, and guilt, because CPR didn't seem to do what it was supposed to do, and they felt guilty for it. Go forth and rescue confidently, and be at peace.
This is the last lesson in the cardiac arrest section, and a difficult topic to tackle for most. Whether you're a licensed paramedic, family member, neighbor, or stranger, the question remains the same for many people:
Why didn't CPR work?
That's a fair question. Even when you do everything perfectly, the desired outcome often isn't what you expected or hoped for.
However, some of that hope and desire can be rooted in a misunderstanding of what CPR really is, which is the point of this lesson. CPR was designed to buy time, and nothing more.
During cardiac arrest the heart is either in a fibrillatory state, meaning it's wiggling around in a disordered fashion, or it's completely asystolic, meaning it's not contracting at all.
When a heart is healthy and operating as it should, it beats from top to bottom in a very organized way utilizing one-way valves. It works perfectly to circulate oxygenated blood throughout the entire body, and it does so efficiently.
However, during cardiac arrest, regardless of what caused it, the heart is unable to circulate blood and oxygen and the body begins to die. The patient isn't breathing. There's no pulse. At this point, that person is clinically dead.
Now, it doesn't mean that person will remain that way, as there is a difference between clinical death and biological death. What CPR aims to do, specifically the compressions, is to make up for the circulation that isn't happening naturally.
The reality, though, is that even when CPR is performed perfectly, it's delivering only a small percentage of what the body needs to survive. It wasn't designed to be equal to artificial life support. Remember, it's simply a way to buy time.
People have this idea that if they perform chest compressions on an unresponsive person, the body will remain alive. And he or she will remain alive so long as the chest compressions continue. But this isn't the case.
CPR doesn't stop the dying process. It slows down biological death a little. But that's all it does. The hope is that after activating EMS or calling in a code, that you can buy enough time until help arrives – an AED, a manual defibrillator, advanced life support, oxygenation, drugs, etc. – and the underlying cause of the cardiac arrest can be addressed.
The truth is that we all have an expiration date. Experienced paramedics who've treated dozens of cardiac arrest victims will tell you that some that should have survived, did not. And some that looked as if they had no chance of survival, did just that.
All you can do is give each cardiac arrest patient the best chance of survival. CPR was never meant to directly save lives. This may sound strange, but the reality is that CPR just keeps people dead longer.
You must approach CPR with this understanding, along with an understanding of cardiovascular physiology. The difference between what CPR really is versus our perceptions of it can be vast. The truth is this: no matter whether we perform high quality CPR, the person remains dead, regardless of who they are.
If you do everything correctly and the patient remains unresponsive, you didn't fail. The patient simply remained dead, for whatever reason.
However, this unfavorable outcome doesn't negate one very important fact – by performing high quality CPR, you gave the patient the best possible chance of survival. Because if you don't perform CPR, except for a bonafide miracle, that person will rapidly go from clinical death to biological death and remain that way.
That's why an important takeaway is this: people in cardiac arrest don't die. They simply remain dead.
Now, you may be asking yourself, if CPR rarely works, is it even worth trying?
EMS professionals will tell you that the people they saved using CPR show amazing amounts of appreciation, as they get to spend another Christmas with their families. They get the pleasure of seeing another birthday come and go.
So, yes, it is worth trying. And in fact, the act of trying should be viewed as a success, as it's own reward, regardless of the outcome.
Imagine if you were in cardiac arrest. There's nothing more beautiful than knowing that someone did everything possible to try and save your life. The effort and the act of helping is all that matters. At least, that's how it should be viewed.
Something to remember – we don't know at what point victims of cardiac arrest can no longer sense or hear what's happening around them. The research is unclear. However, some have come back from cardiac arrest and were able to recount certain aspects of their own life-saving protocol while unconscious.
Even if that person remains dead, there is a chance that their last impression or experience in this physical world was that of love; that someone cared enough (even strangers) to put themselves in a position that might clearly be outside their comfort zone, and risk horrible failure, for that slight chance to help another human being live.
Isn't that the greatest gift we can give to another?
This is why CPR should never be measured in terms of failure and success. Because failure is not making an attempt to help in the first place. The success comes with the effort, and nothing more.
If you've ever performed CPR on a cardiac arrest victim, but the patient still remained dead, hopefully this greater understanding of what CPR really is has brought some peace to you, as the pain, agony, and guilt can be immense.
Go forth and rescue confidently! And be at peace with yourself when you do.