Sudden Death and the Myth of CPR

Rating:
Summary: Loved the book.
Review: I loved this book. It is on a painful topic but it answered some nagging questions for me. My mother died unexpectedly and I never forgave my father for not staying with her during her last moments and always wondered why CPR did not keep her alive. This book provided some answers. It is informative and compassionate.

Rating:
Summary: Informative and caring
Review: I work in emergency medicine and was sure I would hate this book. But I actually like it very much. Timmermans gives a nuanced and empathetic view of resuscitating. He explains how paramedics and emergency room staff are trapped in a double bind. Relatives expect them to save lives but resuscitation techniques rarely succeed in saving lives. The result are unrealistic expectations. Timmermans does a good job exploring the colorful history of resuscitation techniques and the role of insurance companies and managed care. I only wish he paid more attention to automatic defibrillators.

Rating:
Summary: Glaring mistakes undermine the book's intention
Review: If you have any medical knowledge in resuscitation, there are some glaring examples in the book that the author really doesn't know what happens in a resuscitation event. Examples like:
1)"Knickerbocker...noticed that the dogs' blood pressure would increase when he put the heavy fifteen-pound paddles" (50)
2)"...or a prolonged pulseless anginal rhythm..." (122)
3)"LANKER: She must not even have a 60 [heart rate]. JOHNSON: Well, I feel a carotid [pulse]. So it should be at least a 60." (142)

While these examples seem small, the inaccuracies can seriously damage the author's credibility. Using the above examples, here's why:
1) The paddles DID NOT weigh fifteen pounds! The doctor needed to APPLY 15 POUNDS OF PRESSURE to the dogs chest to activate a safety switch. This is what caused the blood pressure to suddenly peak in the dog. We still apply several pounds of pressure to defibrillator paddles today; if the author had read a advanced cardiac resuscitation book he would learn of this.
2)Angina is the wrong word. Angina, or "heart pain" has nothing to do with the situation. Rather, the word should be "agonal" which means "dying".
3)When the nurse here says "60", she is not referring to the heart rate, but blood pressure. (We know this by reading the next line.) There is a big difference between the two, and the difference has clinical significance. (Traditionally, a carotid [neck] pulse, which is mentioned in the next line, indicates that the blood pressure is at least 60mmg.)

The book comes to some very strange conclusions ("Mouth to mouth remains an unarousing sexual act" Page 93) and some vivid and imaginative descriptions of CPR. ("CPR is unusual in the way it brings strangers into intimate contact. First the rescuer "kisses" the unconscious person, then "hits" the person hard. We love life, hate death, love life, hate death in a perpetual rhythm." Page 93)

This is obviously a well-intentioned book, but I feel disappointed in the many mistakes, strange conclusions and unrealistic suggestions. (The author suggests that everyone should carry some form of ID that states whether or not they want CPR done to them. Not only would this be a logistical nightmare, what happens if the card isn't with the person? Will rescuers fear helping people just because they don't have a card? Terrible and frightening idea!)

This is a more of a "thinking" book...it gets you thinking. But if one believes that the book shows all the sides of resuscitation, they are wrong...

Rating:
Summary: A good, but confusing book.
Review: Of the roughly 400,000 "sudden deaths" in the United States each year, only about 1-3% of those undergoing CPR outside the hospital survive. This low figure of survival is accompanied by a high price tag, both economically and emotionally. Timmermans takes a candid look at CPR, exposing its myths and problematic areas, and I found his book historically well researched and balanced. I do have some reservations about some of the misleading statements he makes in chapter 5, especially his mistake of treating 'social inequality' as a synonym for 'unjust', accompanied by the false implication that social value affects survival during a hospital resuscitation effort. On the whole, however, he does a fine job and his extensive historical research and interviews with health care workers make this a fine book. It serves as an excellent antidote to the overly optimistic expectations generated by TV shows and CPR training courses.

Rating:
Summary: "The Dignity of Sudden Death"? Give Me A Break!
Review: Though Timmermans brings up many valid issues in this book, I disagree strongly with the idea of "restoration of dignity to sudden death". This seems like a make-nice way of saying not to upset family members with chest smacking and electric jolts of defibrillation.

Please! Dignity is for bystanders who don't want their sensibilities upset, not for the guy on the stretcher. I know. I was that guy. I may hold the world record for being revived. During a massive heart attack, I was defibrillated 72 times. It took almost three hours of work to bring me back. And guess what? I wasn't the slightest bit concerned with dignity. I just wanted them to keep working until they got me back.

Did I care if my chest was fried from the voltage? No.

Did I care that they stripped me and half a dozen people were handling me? No.

All I cared about was getting back so I could see my wife and I didn't give a tinker's damn what they did to me. Now, it's five years later and I am healthy.

Yes, only a fraction of people who arrest survive resuscitation. But some do. Resuscitation, by definition, is a last-ditch, desperate measure. Admittedly, most victims won't make it. But that's not why we do it. We do it for the ones who DO make it....