DURHAM, N.C. -- A study of three popular television programs has found that
TV portrayals of cardiopulmonary resuscitation (CPR) are two to five times
more successful than real-life situations, according to researchers at the
Durham VA Medical Center, Duke University Medical Center and the University
of Chicago. They say this discrepancy has created a false, and potentially
dangerous, impression about the risks and benefits of this rescue technique.
In the study, reported in the June 13 issue of The New England Journal of Medicine, researchers found that 77 percent of patients receiving CPR on Chicago Hope, ER and Rescue 911 survived their immediate cardiac arrest. Moreover, TV patients were overwhelmingly young, healthy victims of gunshot wounds, car wrecks or similar traumatic injuries -- and all but one patient survived their cardiac arrest with no long-term disability.
In reality, say the researchers, CPR is more than just the emergency roadside rescue technique that many programs imply. The majority of people receiving CPR are elderly or hospitalized patients with heart disease, cancer or other chronic conditions. And, among those who survive the initial resuscitation, many die shortly thereafter or suffer permanent neurological damage caused by their disease or the rescue effort itself.
Researchers say these discrepancies give viewers an overly optimistic impression about the procedure's chances for success and contribute to uninformed decisions about whether to attempt life-sustaining treatments.
"If CPR were a benign and risk-free procedure that offered the hope of long-term survival in the face of otherwise certain death, few people would ever choose to withhold resuscitation," said Dr. James Tulsky, co-director of the program in medical ethics at Duke and co-author of the study. "Controversy surrounds the use of CPR precisely because it can lead to prolonged suffering, severe neurological damage, or an undignified death."
Tulsky said the researchers' intent was not to discourage civic-minded citizens from applying the rescue technique to people in distress. Rather, their goal was to explain why patients and physicians have such widely divergent beliefs about the procedure's benefits and risks.
"In hospitals across the country, patients and physicians struggle with end-of-life decisions that involve whether or not to attempt CPR and other life-sustaining measures," said Dr. Susan Diem, a researcher at the Durham VA Medical Center and lead author of the study. "In subtle but powerful ways, the misrepresentation of CPR on television shows undermines trust in scientific data. Because they appear realistic in many respects, these shows blur the line between fact and fiction."
Diem, Tulsky and Dr. John D. Lantos of the University of Chicago viewed a total of 97 episodes during the 1994-95 season and recorded the patient's sex and age; location, cause, and number of cardiac arrests; who performed CPR; survival rates and long-term outcomes; and number of deaths. Two independent, board-certified internists validated the coding methods by viewing samples of each show and recording data in accordance with the guidelines established for the study.
Among the 60 episodes in which CPR was administered, researchers identified four misleading elements: the success rate of CPR, types of patients who received it, the causes of cardiac arrest, and the likelihood of neurologic damage following the procedure.
The study found that 77 percent of TV patients survived immediately after the cardiac arrest, and 67 percent appeared to enjoy long-term survival. Among actual patients, survival ranges from 2 percent to 30 percent for out-of-hospital cardiac arrests and 6.5 percent to 15 percent for in-hospital arrests -- presumably because inpatients are more ill. For trauma cardiac arrests, survival rates vary from 1 percent to 30 percent, depending on the type of injury.
In addition, the study found that most TV patients either fully recovered or immediately died after CPR, excluding a third possibility of long-term or permanent disability caused by their disease or the CPR itself.
The authors said such depictions skirt complicated ethical isues by avoiding portrayals of the suffering, neurologic damage, or death that may follow the use of CPR.
While the study didn't measure patients' attitudes toward CPR, preliminary results of a follow-up study suggest that patients believe CPR is far more successful than physicians do. Moreover, the profound effect TV has on viewers' beliefs was established in at least two separate studies conducted at the University of South Florida, which found that 70 percent to 92 percent of older patients obtained their information about CPR from television, and these patients tended to overestimate their likelihood of survival after CPR.
Given the discrepancies between TV and reality, researchers say that physicians should acknowledge the false impressions their patients may harbor, then discuss the actual risks and likely outcomes of CPR in an objective but compassionate manner.
The study was funded by The Project on Death in America, a program developed by New York philanthropist George Soros in an effort to improve the care of dying patients in America by promoting change in health care institutions.