Cardiopulmonary resuscitation, better known as CPR, was first discovered in the 1960s and began to be widely adopted shortly thereafter. Nearly everyone has heard of CPR, and if they’ve ever watched television, they have almost certainly seen it being performed on screen. However, unbeknownst to many, there’s a significant discrepancy between CPR on TV and CPR in real life. On television, CPR is often portrayed as being incredibly effective at saving lives, but the reality is far less encouraging.

CPR: Fiction and Fact

To analyse the portrayal and outcomes of CPR on TV, one study reviewed 100 episodes of three popular shows at the time. Within these episodes, there were 60 occurrences of CPR, and 75% of the characters who received CPR survived. These inflated statistics seem to directly influence public perception of CPR’s effectiveness; in another study, family members of critically ill patients were asked about how effective they thought CPR was, and the majority believed that more than 75% of patients survived after receiving CPR.

How do these TV portrayals and public perceptions compare to the truth? In reality, only 7.5% of patients who receive CPR survive to be discharged from the hospital, a figure vastly lower than the 75% depicted on television.

It’s not just about surviving to discharge, either. Among older adults who survive CPR, 1 in 3 will die within the first year. Additionally, many survivors suffer from significant disabilities, such as neurological impairments, reduced quality of life, and physical limitations. This, too, is vastly different compared to the portrayal on television; in the aforementioned study of CPR on television, only one patient out of 60 experienced any sort of disability after receiving CPR.

Why CPR Often Falls Short

CPR’s effectiveness hinges on the ‘Chain of Survival,’ a series of critical steps that must be followed meticulously. These steps include the immediate recognition of cardiac arrest, early and effective hands-on CPR, prompt defibrillation, and advanced cardiovascular life support (ACLS). However, any disruption or delay in these steps can significantly weaken the chain, leading to decreased survival rates and poor neurological outcomes.

There are countless barriers to effective CPR. For example, laypeople often fail to quickly recognize cardiac arrest, delaying the initiation of CPR and emergency services. Nationally, only about 1 in 3 out-of-hospital cardiac arrest victims receive bystander CPR. Furthermore, if a defibrillator is not readily accessible, the chances of survival diminish significantly. Defibrillation is most effective when administered within the first three minutes, offering the highest likelihood of survival. However, after three minutes, the chances of survival decrease sharply and continue to decline with every passing minute. Even the widespread adoption of ACLS, which includes medication administration, advanced airway management, and therapeutic hypothermia, has failed to improve survival rates.

ECPR: The Future of Resuscitation

Fortunately, there is a solution to address the limitations of traditional CPR: Extracorporeal Cardiopulmonary Resuscitation (ECPR). ECPR utilizes Extracorporeal Membrane Oxygenation (ECMO) to provide continuous oxygenated blood flow to the brain and other vital organs during resuscitation. This advanced technique significantly improves survival outcomes compared to traditional CPR.

While only about 7.5% of patients who receive traditional CPR survive to discharge, this percentage increases to 30% with ECPR. The reason for this substantial improvement is that ECPR not only maintains critical organ function but also provides a crucial window for medical professionals to diagnose and treat the underlying cause of cardiac arrest, such as a heart attack or other cardiovascular issues. By ensuring that the brain and vital organs are protected from ischemic damage during this period, ECPR significantly enhances the chances of survival and recovery with good neurological outcomes.

Recognizing the substantial benefits of ECPR, the American Heart Association (AHA) updated its guidelines in March 2024, making ECPR a Level 2a recommendation for the treatment of refractory ventricular tachycardia (V-Tach) and ventricular fibrillation (V-Fib). This updated guideline ranks ECPR higher than the medication amiodarone, which has traditionally been used to treat these conditions. The recognition of ECPR as a recommendation is a significant milestone, finally acknowledging its potential and vital role in improving cardiac arrest outcomes.

Significant progress still needs to be made in terms of expanding the use of ECPR. While only 27,000 patients have received ECPR since 1989, studies estimate that up to 43,030 patients could be eligible for ECPR every year. The AHA’s acknowledgment of ECPR’s efficacy is a crucial first step toward broader adoption, but more efforts are needed to ensure this life-saving treatment is accessible to all who need it.

Innovative Partnerships for ECPR Expansion

Companies like Innovative ECMO Concepts are essential partners in expanding access to ECPR. They play a pivotal role in ECMO program development and expansion, ensuring that institutions are well-equipped to implement and maintain ECPR capabilities. By providing comprehensive support, including staffing, training, and education, companies like IEC not only make ECPR more widely available but also assist institutions in establishing profitable and sustainable programs. This comprehensive approach ensures that ECPR can reach more patients while also maintaining the financial health of the healthcare institutions.