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It's not the CPR that's particularly damaging. Yes, ribs are dislocated (though rarely broken), and cartilage is torn. Those are fairly minor complications though. The 'damage' is done by the medications we push. Drugs like Epinephrine are very good at getting your heart to beat again. A recent study in Japan suggests that that may be at the expense of your brain, and other vital organs. Other drugs commonly used in ACLS resuscitation are equally nasty (Amiodarone, for instance). You're absolutely right that we've gotten very good at getting a heart to beat for a few more days until it succumbs to the damage done to the rest of the body (that 40% figure you mention, though out-of-hospital rates are still much lower than that). The exciting research being done is to improve long term outcomes for cardiac arrest patients. More and more research is showing that the key to a good long term outcome is early compressions, effective compressions (push hard and fast), uninterrupted compressions, and early defibrillation (with an AED or manual defibrillator). Over the past 10 years, resuscitation algorithms have been streamlined to minimize 'off chest' time. Compression to breath ratios have changed (from 5:1, to 15:2, to 30:2). A great deal of emphasis has been placed on keeping the rhythm checks that happen every two minutes as short as possible. We're now teaching people to continue compressions while the defibrillator is charging (and under ideal circumstances, you could easily continue compressions throughout the shock). Intubation is performed without stopping compressions. The focus of all of these changes is to decrease the number of time compressions are stopped. Every time compressions are stopped, it takes some number of compressions to get the pressure built back up in your circulatory system. Fewer interruptions means fewer 'wasted' compressions, and less time that the brain isn't getting perfused. This is obviously key to a good neurological outcome. We like to think all our fancy drugs and advanced interventions are doing something effective, but in reality, 'basic' treatments like CPR and defibrillation are what really save lives, and more importantly, save brain. |