When CPR Doesn't Work

This is the last lesson in the cardiac arrest section, and a difficult topic to tackle for most. Whether you're a licensed paramedic, family member, neighbor, or stranger, the question remains the same for many people:

Why didn't CPR work?

That's a fair question. Even when you do everything perfectly, the desired outcome often isn't what you expected or hoped for.

However, some of that hope and desire can be rooted in a misunderstanding of what CPR really is, which is the point of this lesson. CPR was designed to buy time, and nothing more.

During cardiac arrest the heart is either in a fibrillatory state, meaning it's wiggling around in a disordered fashion, or it's completely asystolic, meaning it's not contracting at all.

When a heart is healthy and operating as it should, it beats from top to bottom in a very organized way utilizing one-way valves. It works perfectly to circulate oxygenated blood throughout the entire body, and it does so efficiently.

However, during cardiac arrest, regardless of what caused it, the heart is unable to circulate blood and oxygen and the body begins to die. The patient isn't breathing. There's no pulse. At this point, that person is clinically dead.

Now, it doesn't mean that person will remain that way, as there is a difference between clinical death and biological death. What CPR aims to do, specifically the compressions, is to make up for the circulation that isn't happening naturally.

The reality, though, is that even when CPR is performed perfectly, it's delivering only a small percentage of what the body needs to survive. It wasn't designed to be equal to artificial life support. Remember, it's simply a way to buy time.

People have this idea that if they perform chest compressions on an unresponsive person, the body will remain alive. And he or she will remain alive so long as the chest compressions continue. But this isn't the case.

CPR doesn't stop the dying process. It slows down biological death a little. But that's all it does. The hope is that after activating EMS or calling in a code, that you can buy enough time until help arrives – an AED, a manual defibrillator, advanced life support, oxygenation, drugs, etc. – and the underlying cause of the cardiac arrest can be addressed.

The truth is that we all have an expiration date. Experienced paramedics who've treated dozens of cardiac arrest victims will tell you that some that should have survived, did not. And some that looked as if they had no chance of survival, did just that.

All you can do is give each cardiac arrest patient the best chance of survival. CPR was never meant to directly save lives. This may sound strange, but the reality is that CPR just keeps people dead longer.

You must approach CPR with this understanding, along with an understanding of cardiovascular physiology. The difference between what CPR really is versus our perceptions of it can be vast. The truth is this: no matter whether we perform high quality CPR, the person remains dead, regardless of who they are.

If you do everything correctly and the patient remains unresponsive, you didn't fail. The patient simply remained dead, for whatever reason.

However, this unfavorable outcome doesn't negate one very important fact – by performing high quality CPR, you gave the patient the best possible chance of survival. Because if you don't perform CPR, except for a bonafide miracle, that person will rapidly go from clinical death to biological death and remain that way.

That's why an important takeaway is this: people in cardiac arrest don't die. They simply remain dead.

Now, you may be asking yourself, if CPR rarely works, is it even worth trying?

EMS professionals will tell you that the people they saved using CPR show amazing amounts of appreciation, as they get to spend another Christmas with their families. They get the pleasure of seeing another birthday come and go.

So, yes, it is worth trying. And in fact, the act of trying should be viewed as a success, as it's own reward, regardless of the outcome.

Imagine if you were in cardiac arrest. There's nothing more beautiful than knowing that someone did everything possible to try and save your life. The effort and the act of helping is all that matters. At least, that's how it should be viewed.

Something to remember – we don't know at what point victims of cardiac arrest can no longer sense or hear what's happening around them. The research is unclear. However, some have come back from cardiac arrest and were able to recount certain aspects of their own life-saving protocol while unconscious.

Even if that person remains dead, there is a chance that their last impression or experience in this physical world was that of love; that someone cared enough (even strangers) to put themselves in a position that might clearly be outside their comfort zone, and risk horrible failure, for that slight chance to help another human being live.

Isn't that the greatest gift we can give to another?

This is why CPR should never be measured in terms of failure and success. Because failure is not making an attempt to help in the first place. The success comes with the effort, and nothing more.

If you've ever performed CPR on a cardiac arrest victim, but the patient still remained dead, hopefully this greater understanding of what CPR really is has brought some peace to you, as the pain, agony, and guilt can be immense.

Go forth and rescue confidently! And be at peace with yourself when you do.