Dismal CPR Outcomes

Even for family members of cardiac arrest patients, CPR retention is overall very poor. Further, despite 40 years of teaching CPR, survival rates have not improved. What is the problem?

Researchers have found that CPR retention and skills deteriorate in as little as a few weeks after initial CPR training. Even for people who would have reason to be highly motivated to learn and retain CPR, retention has been shown to be poor. In a study of parents of infants at risk for cardiopulmonary arrest, only one-third of those participants were able to perform CPR adequately. Similarly, researchers have long documented studies that indicate CPR psychomotor skills deteriorate in a number of populations, including lay persons and health professionals.

Without oxygen, the brain begins to die within four to six minutes. Brain death occurs in ten minutes. Estimates range between 300,000 and 500,000 people die each year from Sudden Cardiac Arrest (SCA). The majority of SCA deaths occur in the presence of family members. Fewer than five percent of those victims survive. Immediate action needs to take place. Refresher training has been shown to be essential and effective. New guidelines that came out in late 2005 were designed to make the skill set for CPR easier to remember and perform. Chest compressions to circulate oxygenated blood are now recognized as critical, and increase the chances that an AED (Automated External Defibrillator) shock will be effective.

The reasons bystanders do not act are complex. As noted, skills may have deteriorated or in a panic, be completely lost. People fear legal repercussions as well as possible health risks. The estimated risk of contracting an infection during CPR is estimated to be about one in a million. Further, if a barrier device is used (mask or shield), the risk is decreased significantly more.

People fear that they will be sued if they try to help and the outcome is not favorable. However, Good Samaritan acts exist in all of the states. In fact, there has never been a successful judgment against someone who provided assistance in good faith. The recommendation is that once CPR is initiated, the rescuer should continue compressions until the scene becomes unsafe, an AED becomes available, s/he sees signs of life or another trained responder takes over or s/he is too exhausted to continue.

Fear of harming the victim is another reason people stand by. They fear they will do “something wrong,” that they will not know how to evaluate the victim’s condition or recognize proper signs and symptoms, or they have a lack of information necessary to take proper medical action. Someone in cardiac arrest is dead (without breathing and a pulse), so it is hard to make them worse. Mistakes in CPR may reduce the chances of reviving the person, but if unsuccessful, it is the cardiac arrest that is the cause of killing them.

Most importantly, a victim’s chance of survival as much as triples when a bystander performs CPR. Every minute counts. Training, instruction, proper equipment and dealing with understanding people’s fears and addressing them are important as we attempt to achieve improved rates of survival.

American Red Cross: Participant’s Workbook: First Aid/CPR/AED for the Workplace, 2006, p. 2.

Dracup, K., Doering, L. V., Moser, D. K., Evangelista, L. (May/June 1998) Retention and Use of Cardiopulmonary Resuscitation Skills in Parents of Infants at Risk for Cardiopulmonary Arrest, Pediatric Nursing, 24(3), pp. 219-227.

Moser, D. K., Dracup, K., Guzy, P. M., Taylor, S. E., Breu, C. (1990) Cardiopulmonary Resuscitation Skills Retention in Family Members of Cardiac Patients

Shenefelt, R. M. (2006) AED, CPR, and First Aid Preparedness for the Real World, Occupational Health & Safety, December.