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

- Rogue Medic

Un-extraordinary measures: Stats show CPR often falls flat


Does CPR (CardioPulmonary Resuscitation) save lives? CNN seems to think that CPR does not work. This article misrepresents the evidence of the results of CPR.

For example, this quote of Dr. David Newman suggest that only one patient a year survives CPR to be discharged from his hospital.

In fact, out of the hundreds of CPR patients who have come to St. Luke’s Hospital in New York, Newman recalls no more than one individual a year making a full recovery.[1]


Is one person per year out of all patients who receive CPR what Dr, Newman really means?

Of all of the patients who received prehospital CPR, does only one patient a year survive?

I have not asked Dr. Newman, because I wanted to write something quickly, but I do not have any reason to believe that this is what he meant.

What Dr. Newman probably meant is that of the patients who come to his hospital with CPR in progress, only about one per year will survive.

What is the difference?

If the patient does not have ROSC (Return Of Spontaneous Circulation – get a pulse back) prior to transport by EMS, the chances of resuscitation are less than 1%.

Yet despite advancements, the overall effectiveness of CPR remains disappointingly low — although the practice still has its defenders.[1]


While we do need to improve our resuscitation methods, there has been dramatic improvement with the focus on exactly what the author is criticizing – CPR. The less we do that is not based on evidence, the better the outcomes.

Continuous fast and deep chest compressions are effective.

This month the LAS (London Ambulance Service) reported their change in resuscitation rates from 2007 to 2012.

In 2010 a number of further initiatives were introduced. One such initiative focussed on the crucial role that bystanders play. More than 30,000 members of the public were trained by the LAS to recognise cardiac arrest and deliver bystander intervention. This training, reflected in an increase in bystander CPR rates during this time, along with an increase in the number of community access automated defibrillators placed in London, may have positively contributed to reducing the time between collapse and effective intervention.[2]


A big part of what they changed was the focus on having bystanders perform CPR.

What was the change in resuscitation rates?

Survival to hospital discharge rates for those meeting the Utstein comparator criteria improved dramatically, increasing from 12% to 32% from 2007 to 2012.[2]


In 2007 the survival to discharge was 12% – not great, but not as bad as the author would have us believe.

In 2012, after increases in bystander CPR and a focus on continuous fast and deep compressions, the survival to discharge increased to 32%.

1/3 of patients survived to hospital discharge.

Not just 1/3 of patients who had bystander CPR, but 1/3 of all patients.

Bystander CPR increased from 55.4% in 2007 to 64.6% in 2012, but what is probably more important is the quality of CPR. No longer were pauses for IVs, intubation, or moving the patient considered acceptable. There is still no evidence that any pause for anything other than defibrillation improves outcomes – not for ventilation, drugs, intubation, or transport to be the one patient per year surviving to discharge after arriving with CPR in progress.

What about in the US, since the author interviewed American emergency physicians?

Despite decades of research, median reported rates of survival to hospital discharge are poor (7.9%) and have remained virtually unchanged for 3 decades (9,10).[3]


That does not look good, but that includes everyone – even those who did not get any bystander CPR. The CNN article is suggesting that bystander CPR does not work, so what are the results for patients who did have bystander CPR?

Although 36.7% of OHCA events were witnessed by a bystander, only 43.8% of these arrests involved persons who received bystander CPR, and only 3.7% of those persons were treated with an AED before the arrival of 911.[3]


The problem is not too much CPR.

The problem is not enough CPR.

Patients who received bystander CPR had a higher rate of overall survival (11.2%) than those who did not receive bystander CPR (7.0%; p<0.01). Improving community bystander CPR rates is an important step towards improving OHCA survival.[3]


That is not great, but it is far from useless. We can increase our survival to discharge rate to over 30% – several places in the US already exceed 30%. The most famous of these is Seattle, which historically has the highest bystander CPR rate in the US.

1/9 patients survived to discharge with bystander CPR.

1/14 patients survived to discharge without bystander CPR.

This includes the patients who are unlikely to survive no matter what is done for them.

That is more than a 50% increase in the survival rate. That is not insignificant. If we can improve the quality of CPR, the rate of bystander CPR, and the quality of EMS treatment, we can save a lot of lives.

CPR, especially without the ventilations, does save lives.

If we limit the analysis to patients who meet Utstein criteria, the numbers improve to 30%.

Click on image to make it larger.

The figure above shows site-specific and aggregate Utstein survival rates for out-of-hospital cardiac arrest events by participating emergency medical services agency for October 1, 2005- December 31, 2010. Utstein survival refers to survival to hospital discharge of persons whose cardiac arrest events were witnessed by a bystander and had an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia. Results varied by agency; the overall Utstein survival rate was 30%.[3]


Why use the Utstein criteria?

The Utstein criteria are designed to permit standardisation between the many reports of cardiac arrest available in literature and hence allow for direct comparisons of the presented data. In addition, the Utstein criteria can be used as a predictor of survival as it is this group of patients that has the greatest chance of a positive outcome.[2]


If you witness a cardiac arrest, that person probably meets Utstein criteria. You should call 911 (or whatever the emergency number is where you are) and then begin fast and deep compressions. Continue until someone can take over for you or until help arrives. If you get tired and can switch with someone else, do so as many times as necessary to be able to continue fast and deep compressions.



[1] Un-extraordinary measures: Stats show CPR often falls flat
By Madeleine Stix, CNN
July 10, 2013 — Updated 1118 GMT (1918 HKT)

[2] Increases in survival from out-of-hospital cardiac arrest: A five year study.
Fothergill RT, Watson LR, Chamberlain D, Virdi GK, Moore FP, Whitbread M.
Resuscitation. 2013 Apr 11. doi:pii: S0300-9572(13)00207-4. 10.1016/j.resuscitation.2013.03.034. [Epub ahead of print]
PMID: 23583613 [PubMed – as supplied by publisher]

[3] Out-of-hospital cardiac arrest surveillance — Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005–December 31, 2010.
McNally B, Robb R, Mehta M, Vellano K, Valderrama AL, Yoon PW, Sasson C, Crouch A, Perez AB, Merritt R, Kellermann A; Centers for Disease Control and Prevention.
MMWR Surveill Summ. 2011 Jul 29;60(8):1-19.
PMID: 21796098 [PubMed – indexed for MEDLINE]

Free Full Text from Morbidity and Mortality Weekly.



  1. Recently took a course on Cardiac Arrest & Resuscitative science which spoke on the topic of hypothermia therapy (I’m probably saying that wrong – it’s late). I found it to be quite an interesting topic. Wondering what your thoughts are on this new (?) concept.

    • (Dr. Abella’s Coursera course on resuscitation was pretty good, far more than I would have expected for laypersons so I was glad he went as deep as he did)

      Therapeutic Hypothermia (TH) is actually an old concept that has been receiving renewed interest in the last decade. In-hospital and pre-hospital studies started in the early 2000’s and many areas have wide adoption. Wake County NC has done it since at least 2007 (my area of NC since 2011) and it is now the standard of post-arrest care for NC as of our 2012 protocols. TH is absolutely the right thing!

      The problem with a lot of resuscitation science is how backwards we are in the easy areas…therapeutic hypothermia won’t make much of a difference if you aren’t doing CPR right.

  2. Rogue excellent job as always with the facts. This article which I have now read 4 times is at best ill informed and a public disservice. As you pointed out the idea that the doctor was only seeing 1 person a year walk out after SCA with CPR in New York seems beyond belief. This seems like a gross editing error;

    “It’s not because Newman has an extraordinary memory or because reviving a patient whose heart has stopped sticks in his mind more than other types of trauma. It’s because the number of individuals who survive CPR is so small.”

    Maybe the doctor was actually talking about trauma related codes with, as you pointed out, ongoing CPR,dunno.

    Another point of the article is that CPR doesn’t work like Hollywood portrays. Seriously that is some investigative journalism right there. I supposed next we are going to hear “Breaking news- zombies are only fictional !”

    Cardiac arrest survival is about the system. Your communities need to have strong links in the AHA chain of survival for high Utstein scores. That means community CPR prior to EMS arrival whether by self initiation or dispatcher assisted and rapid defibrillation with a AED after 2 minutes of CPR. When EMS arrives we should be doing perfect CPR, we own that. The community is the first link in the chain and w/o them the whole system is degraded or fails. The chain is only as strong as the weakest link and telling the community that CPR hardly ever works discourages people to take training or even try when we need them the most.

    I know this journalist received a personal invitation to the next Resuscitation Academy running in Seattle from Dr. Eisenberg. I hope she takes advantage of this and writes a follow up article.

    Thanks Rogue for posting this.

    • At or near adequate ems,

      I know this journalist received a personal invitation to the next Resuscitation Academy running in Seattle from Dr. Eisenberg.

      That is good to hear.

      Dr. Eisenberg is probably the best person to comment on the importance of bystander CPR.

      I would not hold my breath waiting for a correction article, but I don’t know anything about the author, so maybe the author will demonstrate some integrity (if that is the case, maybe the editors will publish it, too). No bated breath, here.


  3. another excellent analysis.

    Thanks for consolidating more useful info, even tho i am a bystander now !


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