Let’s Discuss Performing CPR on Trauma Patients

This week we are going to discuss performing CPR on trauma patients. As with most things, there is some controversy around this subject which is largely a by-product of misunderstandings and bad information.

First things first, I am not (and don’t advocate for you to be) anti-CPR. Somehow, as with many things these days, those that aren’t 100% FOR something suddenly become ANTI that thing. That isn’t the case here. I just want to expand your understanding of CPR and it’s use on trauma patients.

Survival Rate of Patients Who Receive PRE-HOSPITAL CPR is between 1%-11%.

CPR is a great skill. It saves lives. But it isn’t the treatment for every condition despite the fact that the AHA promotes it as if it is a cure all. Look at the billboards, radio ads, TV commercials, celebrity endorsements and other means by which they promote it. In reality, numerous studies have placed the survival rate of patients who receive PRE-HOSPITAL CPR at between 1%-11%. The most commonly cited number for patient survival to hospital discharge is 7%.

The vigorous promotion of CPR to police academies, government agencies and other organizations is what concerns me the most. As discussed in the Trauma for Patrol Officers blog post, these personnel would be much better served with a course focused on Trauma Care. Yes they should get CPR as well but if you have to choose between the two, it is much more likely they are going to be able to save a life with a tourniquet than with chest compressions.

To top it off, the AHA found out that many people won’t do CPR because they are reluctant to “lip lock” a patient they don’t know in order to give breaths. So the latest CPR course for non-medical providers focuses solely on giving chest compressions and not assisting with patient breathing. In reality, the #1 thing you can do for a cardiac patient is hook them up to an AED. The #2 thing you can do is call 911 or rapidly transport them to a medical facility.

CPR on Trauma Patients has less than a 1% Chance of Success

Now for the really interesting part. CPR on trauma patients has a <1% chance of success. (Remember our discussion a few weeks back? That is LESS THAN 1%.) CPR was designed as a treatment for certain cardiac conditions such as a bad heart rhythm. These cardiac conditions are primarily MEDICAL conditions as opposed to TRAUMA conditions. Does this mean CPR never works for trauma? No it does not. Drownings, electrocutions, choking and other TRAUMA related conditions are very amenable to CPR. What CPR does not treat is blood loss.

As previously discussed, the #1 cause of trauma related death is from bleeding. You can’t perform CPR to circulate blood that isn’t there. If the patient is bleeding, you should be taking steps to stop the bleeding, not performing CPR. If the patient’s heart has stopped from blood loss, pushing on the chest (with no other interventions such as a blood transfusion) will not help. The data on this is so clear that the military has instructed their medical providers to NOT perform CPR on the battlefield when there is an active threat, other casualties or mission essential tasks to be performed. In the absence of those conditions, will I still do CPR even knowing there isn’t a realistic chance of success? You bet I will. But you need to have a solid understanding of what CPR will and won’t do. Most importantly, you shouldn’t put yourself at risk or deny care to another patient to do CPR.

To sum it up. Don’t buy into the hype. Know that CPR is a great skill for treating certain medical conditions and limited types of trauma conditions. Also know that using an AED and rapid transport to/calling advanced medical providers is better. Most importantly, never choose CPR over controlling active bleeding, treating another patient, ensuring your own safety or performing a mission essential task.

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Photos Courtesy of Department of Defense. The appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement. Adequate training should be completed from a licensed professional before performing any first aid discussed in this article. This is not medical advice.