Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Gravity and CPR

This is meant purely as constructive criticism. I’ve worked a lot of codes. I’ve made a lot of mistakes. You may want to turn the volume down, or off. There does not appear to be anything but a hysterical family member to listen to.

When CPR (CardioPulmonary Resuscitation) is in progress, we should try to make sure that the patient is as level as practical.

In this video, you can see how easy it is to get tunnel vision and ignore the much simpler ways of moving the patient. One person commenting suggested having the driver pull forward. This may work, but may also lead to communication problems with the driver and safety issues with the car sticking out into the street. The first police car does not appear to be blocking traffic, but with an unknown situation this may be department policy. Going back to move the police car would probably confuse the people on scene and lead to conflict.

The best place to move the patient is probably behind the car. The ground is level and firm and the area should be well protected from traffic, unless someone rear ends the first police car or someone steps out into traffic.

Dragging dead weight (this is what is meant by dead weight) up a hill, even a small one, is much more difficult than dragging them along level ground. If you don’t believe me, try it.

With the body in Reverse Trendelenburg position, the blood will pool in the lower extremities. The blood vessels have probably dilated due to lack of neurological control. Death will do that. The result is that chest compressions may not be any more effective than on a trauma arrest patient. We do CPR on trauma arrest patients just for appearances, not for any benefit to the patient.


Reverse Trendelenburg position image credit.

On level ground, there is also less of a problem with equipment rolling/sliding away.

Apparently, this was a successful resuscitation, but that does not mean that there is no room to improve. We harm our patients when we do not learn and improve from patient to patient. Too many people will try to imitate what they think worked the first time, even though they probably do not understand what worked. We tend to have good luck rituals, or good luck charms, because we do not understand what we are doing. The good luck here was that the police arrived quickly and began treatment.

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Comments

  1. Very well stated. And a good teachable moment in administering CPR.

  2. Agreed. This situation can be used as a teaching tool in CPR classes, but from two perspectives. First, to highlight the good, which is, as you stated, the fact that police arrived and rapidly began treatment. It’s worth noting that there was good rate to the compressions and there appears to be good depth, to the extent that depth can be evaluated from this video. The officers switched compressors (something we, as medics, tend not to do), and the other arriving officer quickly applied the AED and administered a shock when advised to. I know MANY police officers who would not have performed as well as this team did, and I’m sad to say, I also know a good number of medics who also wouldn’t have done this well.

    The second perspective is, as you stated, pointing out areas for improvement. Not to discount the good job these officers did, but working against gravity, as you very eloquently put it, is likely to hamper their efforts at resuscitation, both from a practical “It’s hard to drag dead weight uphill” standpoint and also from a clinical “It’s hard to pump dead blood uphill” standpoint.

    All in all, this video deserves a showing in CPR classes…

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