Bringing people back from the dead, a messy business

An author wonders if CPR is always warranted.

Everyone has seen a movie or TV show where one character is drowning or choking or having a heart attack, only to be dramatically and conveniently revived by another character employing some clever medical technique.

Think of the kid that touches a 10,000 volt electric fence in Jurassic Park, only to have a couple CPR pumps (and some bandaged hands) put him back on his feet. Or John Travolta shooting a veterinary-sized syringe full of adrenaline directly into Uma Therman’s heart, in Pulp Fiction, to counteract the effects of a heroin overdose. Or basically every medical show ever that depicts a couple defibrillator bursts (“CLEAR!”) to the chest curing seemingly fatal heart attacks, gunshot wounds, a really bad case of the flu, whatever.

Well it was perhaps one or more of those tropes—all fictionalized, it’s worth underlining—that made David Casarett want to be an ER doctor. That was until he started learning just how hard it is to really, truly pull someone back from death’s door.

“What happens on TV is very clean and pristine, and very effective,” said Casarett, a professor at the University of Pennsylvania School of Medicine. “CPR in real life is none of those things. CPR in real life involves pushing on somebody’s chest, often pushing hard enough to break ribs…it’s very aggressive. People who have seen CPR for the first time often describe it as looking almost violent.”

Casarett is the author of the new book “Shocked: Adventures in Bringing Back the Recently Dead,” drawn from his time as palliative care physician—a hospice doctor who helps patients that are very ill or at the end of their lives—studying the painful transition from life to death and, every once and a while, the other way around.

He says media often gives people the wrong impression not just about how clean and simple resuscitative techniques are, but also exaggerate the scope of their applicability, or how often they actually work. We’re not just talking about a little dramatic license.

“If you’re watching television, if you’re watching Baywatch the [CPR] success rate is probably 60 or 70 percent. It’s unfortunately not nearly that successful in real life,” said Casarett. “Cardiac arrest in a nursing home, in an older person with many health problems, those patients might only have a one or two percent chance of returning.”Defibrillators are a little better, doctors today have gotten a lot better at restarting hearts, with maybe a “one in three” success rate for healthy people in the right circumstances, according to Casarett. But it’s still far lower than what’s portrayed on TV.

Humans want very badly to believe that with the right training or equipment, it’s common to pull people from the verge. That’s just not how life works, although it certainly hasn’t stopped people from trying, well, basically everything as a last ditch attempts to stave off death. In the 1800s, Casarett says medical “experts” suggested putting people’s feet in boiling water, tickling them with feathers, or beating them with whips.

Some of the techniques actually filtered into today’s portfolio of legitimate lifesaving methods, although much later and probably unintentionally. The antiquated “Russian method” of burying heart attack victims in snow doesn’t actually do much good for for heart attacks, but today some CPR practitioners are trained to ice down subjects to slow their metabolism and extend the amount of time the brain can survive without oxygen.

What Casarett says he really took away from his experiences dealing with patients on the verge of death was that even if survive some trauma because of these efforts, you might actually wish that you hadn’t.

“The other thing we see on TV is that when people revive, they go right back to what they were doing. In reality, it’s not nearly that clean or effective,” he said. “Many of [my patients] were brought back to life, but brought back to life in a condition they really didn’t want to be in.

That grim reality might be why television fantasies tend to gloss over the depressing realities of our medical abilities. In his book, Casareet uses a Greek mythological allegory to describe modern day medicine’s influence over life-threatening conditions.

“Tithonus asked Zeus for immortality, but forgot to ask for eternal youth. So, he stayed alive, he couldn’t die, but he continued to get older and sicker and more frail,” he said. “To some degree that’s what we’re able to do for a lot of the patients that I take care of. We’re able to fix simple problems, we’re able to restart a heart often, but we can’t cure the underlying vascular disease or heart disease or dementia that caused them to get in that situation in the first place.”