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Abstract

We appreciate the comments of Masters et al. They are correct that the general population has misperceptions of the effectiveness of cardiopulmonary resuscitation (CPR) training, based largely on its portrayal on television and in the media. Diem et al1Diem S.J. Lantos J.D. Tulsky J.A. Cardiopulmonary resuscitation on television: miracles and misinformation.N Engl J Med. 1996; 334: 1578-1582Crossref PubMed Scopus (400) Google Scholar surveyed depictions of CPR on American television nearly 30 years ago and found that scenes from medical programs displayed an overrepresentation of traumatic episodes, a much younger population experiencing cardiac arrest, and a much higher rate of survival to hospital discharge than the literature supported at the time. Recent studies have confirmed these findings, despite an ongoing effort to improve public knowledge of resuscitation outcomes.2Jones G.K. Brewer K.L. Garrison H.G. Public expectations of survival following cardiopulmonary resuscitation.Acad Emerg Med. 2000; 7: 48-53Crossref PubMed Scopus (87) Google Scholar, 3Van den Bulck J.M. The impact of television fiction on public expectations of survival following inhospital cardiopulmonary resuscitation by medical professionals.Eur J Emerg Med. 2002; 9: 325-329Crossref PubMed Scopus (48) Google Scholar, 4Portanova J. Irvine K. Yi J.Y. Enguidanos S. It isn't like this on TV: revisiting CPR survival rates depicted on popular TV shows.Resuscitation. 2015; 96: 148-150Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar These misperceptions may be similar to patients' poor understanding of the outcomes of cancer therapy with advanced disease and reflect a lack of knowledge and understanding of critical illness.5Weeks J.C. Catalano P.J. Cronin A. Finkelman M.D. Mack J.W. Keating N.L. et al.Patients' expectations about effects of chemotherapy for advanced cancer.N Engl J Med. 2012; 367: 1616-1625Crossref PubMed Scopus (829) Google Scholar Patients who suffer an out-of-hospital cardiac arrest (OHCA) and do not receive CPR until the arrival of Emergency Medical Services will likely die or suffer significant neurologic injury. Bystander CPR can double or triple the survival rate of OHCA.6American Heart Association CPR facts and stats.http://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRFirstAid/CPRFactsAndStats/UCM_475748_CPR-Facts-and-Stats.jspGoogle Scholar Studies of CPR quality show that even poor-quality CPR results in a higher survival rate than no CPR.7Gallagher E.J. Lombardi G. Gennis P. Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest.JAMA. 1995; 274: 1922-1925Crossref PubMed Scopus (410) Google Scholar In addition, improvements in care paradigms can now result in survival to hospital discharge with good neurologic outcomes in up to 16.3%.8Nichol G. Thomas E. Callaway C.W. Hedges J. Powell J.L. Aufderheide T.P. et al.Regional variation in out-of-hospital cardiac arrest incidence and outcome.JAMA. 2008; 300: 1423-1431Crossref PubMed Scopus (1522) Google Scholar However, <50% of out-of-hospital cardiac arrest victims receive bystander CPR, leading the American Heart Association (AHA) to initiate a campaign to increase the number of persons trained in CPR to 20 million. This concept has been strongly endorsed by the Institute of Medicine's Report on Cardiac Arrest.9Institute of Medicine (IOM) Strategies to improve cardiac arrest survival: a time to act. National Academies Press, Washington (DC)2015Google Scholar Increased bystander CPR, increased availability and use of automated external defibrillators, improved emergency medical service response times, and postarrest care can improve overall survival with favorable neurologic outcomes. However, it should not be overlooked that the most recent AHA statistics show 12% overall survival to hospital discharge from OHCA, which can leave lay rescuers with a significant emotional and psychological burden. Efforts are being initiated to provide assistance and education for the arrest responders. One such resource is www.bystandernetwork.org, an online support environment for individuals who have witnessed a cardiac arrest or have performed CPR. The site provides debriefing and networking with other lay rescuers. The goal is to understand the bystander experience and then provide the support they may need after the event. Nevertheless, we agree with Masters et al that it remains incumbent on physicians and care teams to have frank discussions with patients and families regarding overall health and confounding medical conditions that may distinguish their patient from the healthy young person who may survive a resuscitation on television.