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When I was younger, I'd play all sorts of Dungeons-and-Dragons computer games. One of the big milestones was getting the "resurrection" spell, which would bring life back to some fallen warrior if you got the right dice roll. The game usually balanced the spell so it was quite expensive or had a high failure rate.

In medicine, we call it "resuscitation."

I thought about this today during a Basic Life Support course I had this afternoon. (The American Heart Association offers a take-home version which looks like a creepy version of the game Operation.)

Our instructors were more intense than I expected and some insisted on calling us "doctors", even though we're not quite there yet. I had to keep myself from addressing the leader as "Sergeant", since it felt like he took a break from training Marines to visit us. They refrained from random chit-chat and just kept testing us over and over again on the numbers and procedures. It's definitely the right way to learn these kinds of technical skills. You want muscle memory, not a long thought process.

I hope this time I'll be able to remember the training for longer than a few weeks. Research says that CPR training even among MDs doesn't stick as it should. A 1998 UCLA study trained parents of at-risk infants in CPR. The study showed that important predictors of CPR retention were previous CPR training, social support, and level of anxiety during training. Maybe Sergeant Scare-em was on to something.

The stat the trainer quoted for restoring a pulseless individual to life was 4%; I had heard 3% previously. The CPR success rate jumps to 77% if you only watch it on television. (That study was ten years ago, but I suspect the figure hasn't changed much.)

Even with such a lousy success rate and the possible sequelae of neurologic complications and broken ribs in older persons, the concept that you can actually help someone cheat death is incredibly powerful. Advanced life support (ACLS) adds potions and devices to the mix, making the process even more "magical."

Of course, there is no real magic in the procedure — here comes the science [PPT]. What we do with CPR is push the blood around and keep the lungs stocked with fresh air until someone can shock the hopefully V-fib heart back into a sinus rhythm. I'm not familiar with ACLS, but I imagine it's the same idea applied to a wider set of arrhythmias.

The magic is in the ability of a medic to remember and run these procedures ("spells?") without a second thought, giving someone in need their 4% chance at survival — the ultimate saving throw.

Tags:   acls · bls · cpr · d&dNo Comments