How CPR Works: A PSA For Hollywood

A few days ago I watched the pilot episode of "CSI:Miami" because I figured that a show that stayed on the air that long must have had a good first season. Wow, was I ever wrong. I'm not even sure how that crap-fest even made it to the second episode.

Anyhow, amidst all the completely illogical things that happened in the first ten minutes (eg, the scene of an air crash being investigated by the local CSI crew because the NTSB was going to take a few hours to get there, an investigator wandering around collecting evidence in the Everglades in three inch heels, autopsies being done out in the field, etc.) there was this memorable scene:

CSI guy: "We found one with a pulse!"
Then he yells "Stay with us!" and starts chest compressions (sort of) on the plane crash victim while everyone else stands around and watches him.


This isn't the first time that I've seen this sort of thing, and it occurs to me that maybe the writers in Hollywood are a bit unclear on the concept of CPR, both when it should be used and how it should be done.

Normally it doesn't bother me (that much...) that medical things in shows are often really, really wrong, and the fact that, say, people I know actually believe that blood in your veins is blue and magically turns red when exposed to air... yeah, it makes me laugh, but isn't going to ever do anything but embarrass someone. But CPR is the one thing that the average person on the street may actually be asked to do someday, and therefore it's the one thing that it would really pay for television shows to get right.

So... here's my attempt to clear things up, just in case anyone ever wants to try to get it right:

1) A pulse is a sign that the heart is beating pretty effectively on its own.

2) The point of chest compressions is to pump blood through the body when the heart isn't beating.

3) Ergo (hah, those four years of Latin in high school are really paying off!), if a person has a pulse, they don't need chest compressions.

4) The way chest compressions help pump blood is by compressing the chest enough to force blood out of the heart. (It refills on its own when you stop compressing the chest.) They should really rename them to "heart compressions" because that's the goal.

5) Evolution pretty much went out of its way to keep external forces from compressing the chest, because in normal times having your chest collapse is a really bad thing. There's a reason you have a rib cage.

6) Because of this, compressing an adult's chest enough to squish the heart (which, remember, is what you're trying to do) is hard. Think of it like putting a small water balloon in a shoe box. Tapping on the lid of the box isn't going to do anything. You're going to need to pretty much crush the box. To bring the metaphor back, effective chest compressions need to push the sternum down by a few inches. That will break ribs. If you aren't compressing the chest enough to break ribs, you aren't doing anything useful.

7) You don't have the strength to do this in just your arms -- not even Ax did when he was in his prime. (Not that he's not in his prime now.) You'll need the weight of your body behind the effort, so lock your elbows and use everything in your upper body to push down. You're aiming for a rate of 120 beats per minute, which is about the beat of "Staying Alive" by the BeeGees. I'm sorry I got that song stuck in your head. (No I'm not.)

8) Try that a few times. I'll wait. (Doo do do...) Yeah, it's really hard work, isn't it? Unless you are insanely fit, you're going to be exhausted within a minute or two. Be prepared to hand off the chest compressions to someone else pretty quickly. (Paramedics have a cool machine that will do compressions automatically for just this reason.) (TV people: As an added bonus, this gives all of the actors in the group something to do in this scene. Everyone will be happy!)

9) Don't stop until someone tells you to stop. Or if, you know, you realize the body is in rigor, or has settled to room temperature...

To recap, the wrong way to do CPR is to have ten healthy adults watch one person spend twenty seconds patting the sternum of a victim that already has a pulse and then consoling them because they tried.

On the other hand, for people who drop dead outside of a hospital, the chances of CPR having a good outcome (ie, the person leaves the hospital with a functioning brain) are terrible. I think the number is somewhere around 3%, and that probably includes people that code in the ambulance on the way to the ER.

So don't feel too bad when it doesn't work. After all, as my emergency medicine instructors always said, it's hard to make something alive after it's dead if you can't keep it from being dead in the first place.

And that's the end of our PSA.

Here's a funnier version of the above from the British Heart Foundation:

http://youtu.be/ILxjxfB4zNk