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Useful Notes / CPR: Clean, Pretty, Reliable

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And now, some Real Life Useful Notes about CPR.

If someone near you is not breathing at this moment, call emergency services and let them help you. If your first reaction when faced with a medical emergency is to go to TV Tropes, well, you're probably beyond help.

Common emergency services numbers are:

  • 9-1-1 in North America
  • 1-1-2 in the European Union
  • 9-9-9 in the British Commonwealth and many of its former constituent nations.

Thanks to the Eagleland Osmosis phenomenon, all three of these numbers will redirect you to emergency services almost anywhere around the world. Modern smartphones will often have a separate button to call emergency services, which you can use even without a SIM card. Do this as soon as possible — time is of the essence. You'll find out why later.

This is a Useful Note. It is designed to help readers understand how things work in real life so that you can compare it to how it works in fiction. It's a way for you to do the research rather than actually apply it to your Real Life. Useful Notes are written by Tropers, not medical professionals, and they carry no guarantee of accuracy (or indeed, usefulness) for your situation. We don't particularly want you ruining someone else's life.

With that out of the way, let's talk about CPR in Real Life.


How it works

CPR is the first treatment performed on a person who has collapsed, has stopped breathing, and has no pulse. Its purpose is to buy the victim time before advanced help can arrive. The chest compressions are designed to manually circulate blood through the victim's body, particularly to the brain, which can be irreparably damaged without oxygen for any period of time. This will explain a lot of why CPR is useful for laypeople to know and why it's performed the way it is.

It's important to realise that, with a few exceptionsnote , CPR doesn't "cure" people; it keeps them (that is, their brain) alive long enough to get them the treatment they need, whether that is a Magical Defibrillator or something more advanced.


When someone's heart stops, time is really of the essence, in two different ways:

First, it is essential to start CPR as soon as possible. The body has a very small reserve of oxygen, which lasts about as long as you can hold your breath, but because even perfect CPR is not as efficient as the person's own lungs and heart, that reserve is being slowly depleted even during CPR. The sooner you start CPR, the more reserve you have to work with, and the more time you will be able to buy for help to arrive.

This brings us to the second critical point: Even with CPR, a person's chances of survival drop minute by minute, which means that as important as it is to start CPR, it is even more important to call for help. You should never delay calling an ambulance (or sending someone to fetch an AED if possible) for the sake of starting CPR earlier.

Once the rescuer has started CPR, they must continue until actual emergency responders tell them to stand down, until it becomes dangerous to continue (rising water, spreading flames, etc.), or until they physically can't continue. This doesn't take as long as you'd think; CPR is exhausting, but you can't afford to give up until you have no other choice. Some solo first responders can't even stand after a CPR session just from sheer exhaustion; this is why it's good to have multiple rescuers taking turns administering it. This very short response period is also necessary for use of a defibrillator, which doesn't actually restore a heartbeat but stops "fibrillation", or a quivering, irregular, useless heartbeat; CPR is meant to restore something resembling an actual heartbeat and is always used in conjunction with a defibrillator.

The chest compressions are serious and rough; even if done correctly, there's a substantial risk of breaking the victim's ribs from the sheer force of it.note  That said, in real life rescuers should not worry too much about breaking the victim's ribs; a few broken bones is preferable to being dead. The entire point of the ribcage is to prevent the squishing of the chest contents, which is exactly what you're trying to do. Ultimately, about two-thirds of successful resuscitations involve at least one broken rib.

However, if CPR is done incorrectly, it risks breaking ribs in exactly the wrong place; specifically, it could snap off the xyphoid process at the bottom of the sternum and point a very sharp broken bone directly at the heart itself, which would be fatal (and thus render CPR pointless). This is why formal CPR training is highly important; even those who are certified should get retrained periodically to be up to date on the latest procedures.

If you pay attention, you'll notice that on TV, the rescuer's arms are limp instead of firm, to prevent precisely this from happening to the actor playing the victim.

The undressing aspect of CPR is not usually necessary; clothing should only be removed if it would otherwise obstruct administration of CPR or the defibrillator, or if it's making breathing difficult in some way, as in Of Corset Hurts.

Interestingly, two songs have been proposed as having the ideal beat for which to apply chest compressions: The Bee Gees' "Stayin' Alive", and Queen's "Another One Bites the Dust". Choose whichever you prefer based on your level of cynicism.

Mouth-to-mouth resuscitation is a staple of CPR on TV because it has romantic healing connotationsnote . That said, it's used sparingly in real life these days, mostly because of the risk of the rescuer catching any number of nasty diseases from the patient; The small amount of ventilation from the chest compressions still allows some oxygen exchange, and the slightly lower efficiency is considered a fair trade-off for the rescuer's safety. When used, mouth-to-mouth will often be done with a special mask to avoid direct contact with the mouth for this reason; if you have CPR training, you should consider keeping a CPR mask with you, just in case.

Occasionally, you might see a variant of the "precordial thump" used as part of CPR on TV. The "precordial thump" is a now-outdated technique where the heart is restarted with a precisely-timed blow to the chest. It's essentially a last-resort maneuver. On TV, it provides an opportunity to revive someone by whacking him indiscriminately on the chest, and it's more used as a variant of Magical Defibrillator than this trope.

And as an aside, since at least 1990, no one has advocated any sort of intracardiac injection during the process.

Success rates

CPR in real life isn't as reliable as anyone would like it to be; the chance of recovery is usually less than 10%, even with medical intervention. Furthermore, even after keeping the patient alive, doctors have to find a way to get rid of whatever induced CPR conditions to begin with, which isn't always possible; many patients die within one or two years even if CPR does save them. Furthermore, if the brain has spent even seconds without oxygen, there may be permanent brain damage.

That said, CPR can be more effective in some situations than others. The most likely chance of success is with drowning victims; successful CPR can revive them back to consciousness, and people who are quickly recovered have a comparatively high chance of long-term success (although seawater can cause serious lung damage). It's also slightly "prettier", because the water makes the vomiting look cleaner. The other best-case scenario is cardiac arrest in a healthy heart, most often due to an electric shock; the lack of structural damage or underlying illness means that CPR can serve to "get the heart going again", making this the closest possible thing to "miraculous resurrection" that CPR can provide, if it's performed immediately.

Then there are some situations where a patient has collapsed and CPR is 100% unreliable, such as cyanide poisoning; even if you can circulate oxygen through the patient, the toxin prevents the body's tissues from absorbing it. And if it was ingested orally, the cyanide could kill the rescuer too if he does mouth-to-mouth improperly.

Similarly, performing CPR on a trauma patient is usually a last-ditch effort, and unless there's a medical team actively resuscitating the patient, it's unlikely to succeed.

There are some historical cases of people who have made near-complete recoveries despite being treated with CPR for an absurdly long time, but these just serve to show how quick the first response has to be. A famous example is English footballer Fabrice Muamba, who suffered a cardiac arrest and collapsed on the pitch. Medics were on him within seconds, gave him 78 minutes of CPR, 15 defibrillator shocks, and various drugs in the hospital before his heart resumed beating. The point of this is that since he was never in a position where the brain was actually losing oxygen, CPR gave doctors time to restore his heartbeat. It also illustrates why first aid kits and AEDs are ubiquitous in public places, particularly gyms and sporting venues.


People have been trying various methods to revive the dead for centuries, and this led to techniques such as the Silvester method in the late 1800s and the Holger Nielsen method circa 1900, but these only really worked on a victim whose heart was still beating. CPR itself is Newer Than They Think; it was only developed in 1957, and public education on it began in the 1960s. Technically, the defibrillator predates CPR. This is why you can expect some works set in The '50s to have characters unfamiliar with CPR (e.g. it being described in M*A*S*H as a revolutionary new technique or the "What's CPR?" gag from Back to the Future Part II).

How to learn

If you still want to learn how to actually be a first responder, go ahead and learn from someone who's actually certified to teach you; it can be truly valuable in certain fields of employment, and certification courses are widespread. A good place to look is your local Red Cross or a national affiliate (e.g. Red Crescent in predominantly Muslim nations, Magen David Adom in Israel, or the secular Red Crystal organization).

We can also direct you to The Other Wiki for some even more detailed and technical explanations.

Back to CPR: Clean, Pretty, Reliable


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