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Sudden Death and the Myth of CPR
by Stefan Timmermans
Temple Univ. Press
272 pp.; $22.95, paper
There are roughly 400,000 sudden deaths each year in the United States. Among patients hospitalized on general medical or surgical floors who receive cardiopulmonary resuscitation (CPR), only about 15 percent are estimated to survive. For those who receive CPR outside the hospital setting, estimated survival rates are even more pessimistic, dismally ranging from 1 to 3 percent. Of those few who do survive long enough to leave the hospital, most studies show significant neurological deficits in at least half of them.
By contrast, a 1996 analysis of resuscitation on three popular television shows found unrealistically high survival rates. For ER, Chicago Hope, and Rescue 911, immediate survival was an absurd 75 percent. Long-term survival was an equally astounding 67 percent, With such a gap between reality and fantasy, Stefan Timmermans's Sudden Death and the Myth of CPR is a timely expose of a resuscitation system badly in need of reform.
Extensively researched and footnoted, Timmermans's book is also pragmatic. Catalyzed by some deaths in the author's close-knit family, followed by extensive research reading, Timmermans's project ultimately included numerous interviews with sundry professionals involved with CPR and Advanced Cardiac Life Support (ACLS) resuscitation procedures (called "codes").
Indeed, Timmermans did not merely interview physicians, nurses, paramedics, chaplains, and ER technicians but journeyed out of the classroom to become incarnationally involved in the resuscitation community, observing 112 resuscitative efforts in emergency departments of two hospitals over a fourteen-month period, wearing a beeper so he could be paged to the hospitals when a "code" was coming in via ambulance. He also did volunteer work in one of these hospitals, formed friendships with staff members, learned CPR, and took an emergency medical technician course.
Nevertheless, hanging around health care professionals is no substitute for being one, and this book occasionally suffers from lack of insight that can only come from working within the field. Because of this, some of the conclusions and many comments made about emergency department resuscitations should be taken with a grain of salt. Among other things, the book (especially chapter 5) makes the mistake of treating "social inequality" as a synonym for "unjust." Timmermans falsely implies that the social value of a patient (e.g., a young patient or socially prominent citizen versus an elderly patient or one suffering from a drug overdose) affects their chances of survival by influencing the aggressiveness of the resuscitative effort.
Fortunately, this book is on the whole balanced and insightful, bringing a welcome challenge to the perceived success and prevailing dogma regarding "universal" CPR. Timmermans persuasively argues for selective use of CPR where it is more likely to be successful (as in hypothermia, drowning, or electrocution) and withholding CPR to allow death with dignity for others (as in terminal health conditions such as cancer or advanced cardiac disease). He proposes reforms for a resuscitation system that is currently both very expensive and highly ineffective. As a resource for recounting historical development of resuscitation techniques over the last few centuries, this book is first-rate. And for anyone undergoing CPR or ACLS training, it provides a valuable corrective to the overly optimistic expectations generated by such courses.
—David Graham
The Book on the Bookshelf
by Henry Petroski
Alfred A. Knopf
290 pp.; $26
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