Sep 24, 2013

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: When you watch your favorite TV show, you see somebody collapse and then somebody else comes to the rescue and administers CPR and they come back to life and everything's good. But is it really that effective in real life? With Dr. Troy Madsen, emergency physician at the University of Utah Medical Center. Does CPR work?

Dr. Madsen: I think the short answer to that question is yes. Does it work as well as we think it works based on TV shows? The answer there is no. Unfortunately, TV shows have kind of created an unrealistic expectation for us. I saw something that said when people perform CPR on TV shows or in movies, 75% of the time that person lives. That's not the case.

Interviewer: That's not real life.

Dr. Madsen: It doesn't happen that way, unfortunately. That number is probably closer to 5% realistically. A lot of it depends where the CPR occurs and who's doing it.

Interviewer: So, 5%, that doesn't sound very successful. Should people even bother to learn CPR?

Dr. Madsen: Well, those aren't great odds but it's all you can do. You figure the person's chance is 1 in 20 of surviving, but on the other hand you could save that person's life. So, absolutely I think it's worth doing and it's worth trying to see if you can make a difference.

Interviewer: So, even myself as a civilian who maybe took a CPR class two, three years ago, I don't exactly remember what I'm doing. Should I start pounding on the chest or not?

Dr. Madsen: Go for it. Jump in and do it.

Interviewer: Really?

Dr. Madsen: The wonderful thing about CPR that's come out in the last couple of years, maybe even since you had your last CPR class, is that they've made it really simple. Forget the breaths. Forget trying to blow in a person's mouth. I think people think about that; it just grosses them out. Just do chest compressions. And when you do them think of the song "Staying Alive." So, you think about that '70s disco song, it's 100 beats a minute and that's what you're going for. You're doing deep chest compressions, 100 beats a minute and just keep pushing on that person's chest until the ambulance gets there.

Interviewer: And just for a refresher course, you put your hands right on their heart? Is that where you're pressing?

Dr. Madsen: So, you're going to put it right over their sternum. So, if you feel on their chest, the hard bone . . .

Interviewer: More in the center.

Dr. Madsen: So, right in the center of the chest, exactly.

Interviewer: Okay.

Dr. Madsen: So, you're going to get right over the center of the chest, right over that really hard bone about halfway up and then get right over them with your fists down on the chest with your arms straight out and locked. Get your full force over them. We say to our medical students when you're doing CPR if you're cracking the person's ribs, you're doing the right thing.

Interviewer: Wow, really?

Dr. Madsen: Because you have to get that much force. You have to get down and really push on the heart. If you're breaking ribs, it's fine. Again the person's chances of living are 1in 20. We can easily treat broken ribs. You're saving their life potentially.

Interviewer: Absolutely.

Dr. Madsen: Another thing to keep in mind is you can get really tired doing CPR, you know. People tire out in maybe two minutes with those chest compressions, so if there are other people there, rotate out. Have people swap in. Keep the chest compressions going. Studies that have been done have shown that good chest compressions save lives. So, if you're doing the right thing, the right compressions, you could make a difference.

Interviewer: And how long should you keep that up before you just stop?

Dr. Madsen: Keep going until the ambulance gets there.

Interviewer: Gotcha.

Dr. Madsen: Once they get there they may find something that they could do quickly to potentially do something different. The big thing they're looking for is something where they can shock the heart. So, this is the other thing to keep in mind too. If you're in a place that has an AED, or an automated external defibrillator, like a school or a public building, get that. Put it on there. It's pretty much fool proof. It'll tell you if you can shock and if it says shock you push a button, it shocks the heart and that's the number one thing that can make a difference.

Interviewer: So, as I'm doing these chest compressions and I'm just going and going and going, am I looking for any signs of consciousness or am I just really doing the heart's job at that point, keeping the blood going around?

Dr. Madsen: So, as you're doing the chest compressions, you're going to take a very short break every minute or two, see if the person's breathing. You can just kind of lean over, you can feel for a pulse as well. And if it's not, you just keep going. So, that's the thing you're watching for, any sort of breathing, and any sort of a pulse. But in most of these situations, you're probably not going to get that, and hopefully in most situations you're going to have an ambulance there within five minutes.

Interviewer: If you're not getting that are you doing any good?

Dr. Madsen: You are. You are pushing blood to the body and to the brain.

Interviewer: So, you are. You are actually doing the heart's job at that point.

Dr. Madsen: Yeah. You are. You are doing the heart's job because you're pushing down, causing the heart to squeeze that blood out, and you're making a difference. And I can tell you I've had cases, certainly I've had many cases where we've done CPR and the person hasn't come back. But I've had cases where they have started CPR, person has been completely unresponsive, they've been out for 10, 15 minutes basically dead, doing chest compressions. We were able to shock the heart, get it back in rhythm. And the one case I'm thinking of in particular, the guy walked out of the hospital two days later, totally back to normal. Just absolutely remarkable. So, that can happen, and that's the reason you do CPR all these times is hopefully to have that one case where you save a life.

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