The most iconic movie scene of a person being resuscitated I can remember was Uma Thurman in Pulp Fiction. After she snorts some heroin, thinking it was pure snow cocaine, overdose hit! Her partner for the night, Vincent (John Travolta) made some phone calls and got his hands in an extremely visual appealing adrenaline syringe (10cm needle) and injected it right into her heart! She jumped like a guy receiving an unadvertised rectal! Read to roll again! Well, although it seems bizarre to us, that’s exactly what my old man thinks I do in ICU (at least the adrenaline part), but life sucks, and we know how life sucks when beaten up to death during a cardiac arrest!
Let me refresh you about the terrible outcomes after an arrest with some numbers. The BRESYS study , a survey of 3765 cardiopulmonary resuscitations in British hospitals, found that “for every eight attempted resuscitations there were three immediate survivors, two at 24 hours, and one alive at one year. Survival at one year was 12-5% including out of hospital cases and 15-0% not including these cases’’.
How about the neurological outcomes after CPR? It’s kinda hard to predict what will happen to those hypoxic brains when they don’t wake up. You all probably saw that once healthy 40y/o fellow who “survived” a 40min arrest and today lives in a long term care facility, breathing through a tube in his neck, fed by another tube in his stomach, no interactions whatsoever, a pneumonia here and there, sometimes he seems to be staring at you, maybe. In fact, he is at the roof’s edge, waiting for The Day!
Enough sadness for today! I’m here to to talk about two of the best studies ever done (arguably)! The first one was conducted by Susan Diem and some lazy colleagues: Cardiopulmonary Resuscitation on Television, Miracles and Misinformation . That’s right, a group of scientists decided to critically analyze the television CPR outcomes. Since I have a Masters in Netflix and a PhD in Youtube, the task of analyzing them came to me! They quote a study  which found that 92% of patients older than 62y/o reported to obtain useful information about CPR from television! Yeah, we’re doomed!
Methods: While you spend hours at pubmed, or searching through articles, these geniuses just bought some popcorn, some Coke and some skittles, sat they butts on a comfortable couch and spend 2 years watching episodes of ER and Chicago Hope, plus 50 consecutive episodes of Rescue 911. Now, you wanna know the best part? They published the results in The New England Journal of Medicine! Eat that, suckerrrsssss!
The results: in the 97 episodes of ER(25), Chicago Hope(22) and Rescue 911(50), they observed 60 CPR (only 35% in elderly), with an astonishing 77% immediate survival (ER=64%, Chicago Hope=65%, and Rescue 911=100%), also, 67% of patients were discharged alive from hospital. They concluded that television is giving the wrong idea to the lay public, and maybe that’s one of the reasons why people usually overestimates the outcomes after a cardiac arrest. They also concluded that Rescue 911 was more miraculous than Jesus himself!
Almost 15 years later, D. Harris and H. Willoughby, decided it was about time to replicate this amazing research. They reviewed sequential new episodes of four television medical dramas screened during 2008-2009: Casualty (26 episodes), Holby City (25 episodes), Grey’s Anatomy (23 episodes) and ER (14 episodes). Surprisingly, they found different results. In fact, of the 70 CPR attempts, immediate survival was 46% (Casualty=42%, Holby City=57%, Grey’s Anatomy=46% and ER=41%). The overall immediate survival rate was not significantly different from actual resuscitation survival (p = 0.48). They concluded that CPR in television medical drama does not significantly differ from published results of actual resuscitation survival.
I don’t know if Dr. Carter’s (ER) team got worse, or if was the impact of Grey’s Anatomy (Shonda Rhymes used to kill everyone on that show), but maybe television medical dramas are getting more realistic, at least in terms of CPR outcomes. There is only one problem. Both studies couldn’t find many information about long term outcomes or neurological recovery, jeopardizing any statistical analysis. This is one point the general public must be aware of. Schonwetter found that after giving information about CPR outcomes to 1002 patients, their CPR preferences changed in three of five hypothetical clinical scenarios (p<0.05). Those who were more realistic in their estimates of CPR survival desired less CPR in the hypothetical scenarios (p < 0.01).
To wrap it up! There is a real need in destroying the myth behind cardiopulmonary resuscitation. People need trustworthy information about short and long term outcomes. The ultimate problem is choice, and only education can prepare our patients to make that choice. Let the Pulp Fiction to the big screen. I think I’m gonna work on a Netflix review. JAMA, here we go!
1. Tunstall-Pedoe H, Bailey L, Chamberlain DA, et al. Survey of 3765 cardiopulmonary resuscitations in British Hospitals (the BRESUS study): methods andoverall results. BMJ. 1992 May 23;304(6838):1347-51
2. Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television: miracles and misinformation. NEJM 1996;334:1578–82
3. Schonwetter RS, Walker RM, Kramer DR, Robinson BE. Resuscitation decision making in the elderly: the value of outcome data. J Gen Intern Med1993;8:295-300
4. Harris D, Willoughby H. Resuscitation on television: realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama. Resuscitation.2009 Nov;80(11):1275-9