As Seen On tv
I have mixed feelings about medical dramas…. They tend to be triggering for those of us in medicine. The gold standard, until recently, was E.R. [I mean George Clooney, Noah Wyle…]. It was probably the most realistic portrayal of what goes on in an emergency department (but 4000%, surgeons do not hang out in the ER treating patients). The Pitt emerged as a blockbuster fan favorite last year and, in my expert opinion, is the most medically accurate show in history. It deserves its own discussion. But backing up a bit, from the mid-’90s (ER) to now, there has been a steady stream of medical sitcoms and dramas—most notably Grey’s Anatomy, Scrubs, and House. There are dozens of others that have come and gone over the past few decades. Each has carved out its niche—romantic melodrama (no, we don’t go around cutting LVAD wires for boyfriends), comedy, mystery, etc.—stretching reality, understandably, to appeal to audiences.
But how do these series depict cardiac arrest and, more importantly, survival after cardiac arrest?
Some basic terminology first. “Cardiac arrest” means the heart has stopped as in you are almost dead or will be in the very near future. It is the final common pathway resulting from a variety of medical insults. Some are fixable and some are not.
In a (somewhat older but still relevant) study published in the New England Journal of Medicine, researchers watched every single episode of ER and Chicago Hope for a year (fun!) and found that 75% of patients survived the initial cardiac arrest and 67% survived to hospital discharge—most portrayed as neurologically intact. Another study surveyed individuals about CPR knowledge and found that television was the primary source of information for 90% of respondents. These studies predated social media, and today we are arguably even more likely to absorb medical “knowledge” from media than from research studies or textbooks. .
A 75% chance of surviving after your heart has stopped sounds well… not so bad.
But the reality?
It’s not rainbows and sunshine. The chance of surviving an out-of-hospital cardiac arrest is less than 10%. Survival improves significantly when the arrest is witnessed and CPR is started immediately—but still nowhere near television standards. On TV, survivors often walk out of the hospital seemingly unchanged. In real life, survival to discharge is just above 20% for in-hospital arrests, and only about 15% overall have favorable neurological (brain) recovery.
Television also gets the “who” and “where” wrong. Cardiac arrests on screen tend to occur after trauma, in public places, and in younger patients. It’s more dramatic that way. In reality, most cardiac arrests occur in older adults, are caused by medical conditions rather than trauma, and happen in private homes (well over 90%).
Which means—even if you don’t feel compelled to help a random stranger—think about having these skills for the people you love and live with.
Many people take a CPR/AED course simply because they have to check a box. Let’s reframe that: learning CPR and how to use an AED is an essential life skill. If CPR and AED training aren’t already on your list, I hope you’ll consider adding them.
That’s it for now. We’ll talk about The Pitt later….
-Susy
References
Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television. Miracles and misinformation. N Engl J Med. 1996 Jun 13;334(24):1578-82. doi: 10.1056/NEJM199606133342406. PMID: 8628340.
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Okubo M, Komukai S, Andersen LW, Berg RA, Kurz MC, Morrison LJ, Callaway CW; American Heart Association’s Get With The Guidelines—Resuscitation Investigators. Duration of cardiopulmonary resuscitation and outcomes for adults with in-hospital cardiac arrest: retrospective cohort study. BMJ. 2024 Feb 7;384:e076019. doi: 10.1136/bmj-2023-076019. Erratum in: BMJ. 2024 Apr 18;385:q900. doi: 10.1136/bmj.q900. PMID: 38325874; PMCID: PMC10847985.
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