Opinion : Emergency CPR

Submitted as part of my medical ethics class:

Many people would agree that there are many cases of waste in the American healthcare system that could be reduced if physicians would back down from using aggressive treatments. Often these treatments are costly and have low probability of success, wasting both staff and financial resources. A good example of this is the emergency cardiopulmonary resuscitations (E-CPR) outlined in this week's article. I believe that these are a waste of resources and should not be performed until further technology is developed that significantly improves outcomes.

Many physicians consider death as a failure and do anything to prevent it. Unfortunately, in cardiac resuscitations, they are rarely successful. According to this study, only about 10% of patients successfully have their heart restarted, less than 1% ever regains consciousness, and no one in this study survived to be discharged. (1) The co-morbidities and causes of the arrest ranged from nothing, to Cancer to CAD, and only congestive heart failure showed any survival improvement, and even then lee than half the patients survived. No one with stroke or hypertension was successfully resuscitated. (1) With present techniques and technology, E-CPR is simply ineffective as a medical treatment.

If E-CPR were cheap and easy, or we had unlimited resources, then we might argue that it can't do any harm, so why not give it a try on everyone, even if it rarely helps. Unfortunately, these ideal conditions do not exist, and resources that are used on ineffective treatments are resources that are wasted. In this case, it is estimated that taking care of those who were successfully resuscitated averaged over $5000 (removing an outlier who cost over $95k) (1). The hospital also spent almost $150,000 just to get to those few successful cases (1). That is a steep bill for treatment that did not actually save any lives. It is not clear whether that accounts for staff costs, but it clearly does not take into account the other hospital resources that were used, including ER beds and equipment. The end result of providing E-CPR to all these patients was likely to cause longer ER wait times for the other (presumably surviving) patients and ultimately raise insurance premiums. This clearly does not benefit the community, although this would be more difficult to determine if even one life had been saved.

This study indicates that E-CPR is an ineffective and wasteful treatment. Its use should be restricted immediately and further research should be performed to determine ways to improve cardiac arrest outcomes.

1. Gray, WA. Capone, RJ. Most, AS. Unsuccessful Emergency Medical Resuscitations: Are continued efforts in the ED justified?. NEJM. 1991. pp1393-1398