Sudden Death and the Myth of CPR

Sudden Death and the Myth of CPR

Stefan Timmermans
Foreword by Bern Shen
Copyright Date: 1999
Published by: Temple University Press
Pages: 272
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    Sudden Death and the Myth of CPR
    Book Description:

    Sudden Death and the Myth of CPRis for anyone who has taken a CPR course or who believes the images from television dramas. It is also for families of victims and survivors of CPR. It will engage emergency personnel, others in the medical field, and anyone concerned with ethical issues of death and dying.Anyone who has ever taken a CPR course has wondered, "What would happen if I actually had to use CPR?" In Western societies, the lifesaving power of resuscitation has the status of a revered cultural myth. It promises life in the face of sudden death, but the reality is that lives are rarely saved. Medical researchers estimate the survival rate for out-of-hospital CPR to be between 1 and 3 percent.Sudden Death and the Myth of CPRexplores the history of this medical innovation and the promotion of its effectiveness.The overuse of resuscitation, Timmermans explains, defines people's experience with sudden death, something he learned firsthand by following the practice of lifesaving from street corner to emergency room. He argues that very few people are successfully resuscitated without brain damage despite the promotion of CPR's effectiveness through powerful media images. In vivid accounts of the day-to-day practices of cardiopulmonary resuscitation in one of the only studies o f sudden death, Timmermans records the astonishingly frank comments of emergency personnel. Doctors, nurses, social workers, and paramedics express emotions from cynicism about going through the futile motions to genuine concern for victims' family members.If a person who was supposed to keep on living dies at the end of a resuscitative attempt, how socially meaningful is the dying? Timmermans asks tough questions and addresses the controversial ethical issues about the appropriateness of interfering with life and death. He suggests policy reform and the restoration of dignity to sudden death.

    eISBN: 978-1-4399-0513-5
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. Foreword
    (pp. xi-xiv)
    Bern Shen

    This book examines a topic that has received surprisingly scant attention, despite the roughly 400,000 sudden deaths per year in the United States. How is it that a whole industry has grown up around cardiopulmonary resuscitation (CPR) when it seems to be so rarely successful? In exploring the answer, Stefan Timmermans meets the difficult challenge of articulating a common ground of interest for emergency medical staff, basic researchers, ethicists, sociologists, anthropologists, policy wonks, and that large and important constituency lumped under the inadequate rubric “lay readers.”

    Those who work in emergency medicine—first responders, paramedics, nurses, physicians, social workers, respiratory...

  4. Preface
    (pp. xv-xx)
  5. Introduction: What They Didn’t Tell You in Your CPR Course
    (pp. 1-10)

    It is 9:35 on a Thursday evening in February. The weather forecast predicts sleet and maybe an ice storm. Ruth Berns,¹ an emergency department (ED) nurse, shivers when she pulls the curtain around a patient’s bed. She thinks of her husband, a firefighter and avid motorcycle rider. “I hope he’ll be safe tonight,” she prays. When she walks back to the nursing station, she quickly glances at the patient board. With the weather forecast, this could be a busy night in the ED. Until now it has been rather quiet: a nursing-home patient’s broken finger, a child with a sore...

  6. 1 Death Awareness in the United States
    (pp. 11-30)

    In her best-selling books, Elisabeth Kübler-Ross crystallized an emerging recognition in the late sixties that something had gone profoundly wrong with the way people died. She and other researchers noted that death had become a taboo topic in Western cultures and that the dying experience lacked the significance it once had. Over time, the perceived “good” community death had disappeared and had been replaced with a depersonalized, anxiety-filled hospital passing. Instead of integrating death into everyday life, Americans had expelled the dying to hospitals, where they hoped for a quick medical fix. In response, health-care professionals, scholars from a variety...

  7. 2 The Search for the Best Resuscitation Technique
    (pp. 31-55)

    Medical texts regularly locate the origins of the current resuscitation techniques in biblical passages such as this one about the Prophet Elisha:¹

    32 And when E-li-sha was come into the house, behold, the child was dead, and laid upon his bed.

    33 He went in therefore, and shut the door upon them twain, and prayed unto the Lord.

    34 And he went up, and lay upon the child, and put his mouth upon his mouth, and his eyes upon his eyes, and his hands upon his hands: and he stretched himself upon the child; and the flesh of the child...

  8. 3 CPR for All
    (pp. 56-89)

    In the early sixties, a leading group of resuscitation researchers agreed that CPR—the combination of securing an open airway, mouth-to-mouth ventilation, and chest compressions—was the most promising resuscitation technique. CPR addressed the often fatal problem of an obstructed airway. Further, it incorporated the most successful techniques for artificial ventilation and, for the first time, had the potential to maintain circulation. Important to the reception of CPR was that it did not require props or surgical intervention. It was ideal for both the hospital and the field. Furthermore, it was simple to learn, relatively easy to perform, and not...

  9. 4 Lifesaving in Action
    (pp. 90-114)

    Margaret Mouton,¹ a 64-year-old African-American woman, had recently lost her husband in a traffic accident. She was devastated. Her husband would have retired in a few months. Her stepdaughters worried about the difficult grieving process. They took turns staying with her. The morning of October 23, Margaret smiled while gazing out the window, and her oldest stepdaughter caught the smile, and then left for an errand, thinking, “It will be all right. Mom will work through it.”

    Shivering, George Daniels closed the door behind him one early morning in March. If he hurried, he could jog to the third bridge...

  10. 5 Deciding Life and Death
    (pp. 115-152)

    In 1967, the sociologist David Sudnow offered the following advice: “If you anticipate having a critical heart attack, keep yourself well-dressed and your breath clean.”¹ Sudnow was the first to note that whether a patient lives or dies at the end of a resuscitative effort depends to a certain extent on the emergency department staff’s interpretation of striking social characteristics—such as the patient’s age, “moral character,” and clinical teaching value. The staff regarded certain groups of people as “socially dead,” meaning that “a patient is treated essentially as a corpse, though perhaps still ‘clinically’ and ‘biologically’ alive.”² Sudnow explained...

  11. 6 “There Is a Code and a Code”
    (pp. 153-183)

    Resuscitative efforts are emergencies for relatives and patients, and routines for medical professionals.¹ The casual conversations during compressions and ventilations, the laid-back attitude of some health professionals, and the ease with which a resuscitative attempt is incorporated into the daily schedule and forgotten afterwards implies that most lifesaving efforts are routine work. The staff rarely become overwhelmed by the life-or-death situation. Still, not all resuscitative efforts in emergency departments are routine for the staff. In some cases and for some health-care providers, resuscitative efforts require extra adjustments, sometimes institutional and technical, but mostly psychosocial under the form of debriefing or...

  12. 7 Saving Life or Saving Death?
    (pp. 184-206)

    After celebrating CPR for two hundred fifty pages, the emergency system researcher and physician Mickey Eisenberg becomes less confident and convincing at the end of his book when he asks the fundamental question:

    Should we attempt to reverse sudden death? Ultimately the only answer must be personal. And it must be addressed before the event, since those in cardiac arrest cannot make their wishes known. Most of us, I believe, would want to be resuscitated from ventricular fibrillation (assuming a basically healthy heart), but would we decide to be defibrillated if there was an underlying terminal condition (such as Alzheimer’s...

  13. Appendix: Methodology
    (pp. 207-212)
  14. Notes
    (pp. 213-232)
  15. References
    (pp. 233-248)
  16. Index
    (pp. 249-256)
  17. Back Matter
    (pp. 257-257)