Minnesota 2020 Journal: Resuscitation Time Matters
Don’t stop too soon. That’s the lesson of a recently released cardio-pulmonary resuscitation study. Emergency care providers may be suspending CPR too early. Longer application may provide additional, critical healthcare benefits. Stopping too soon may compromise or potentially negate CPR’s life-saving impact. Extra minutes matter.
Incidentally, economist John Maynard Keynes observed the same thing about economic stimulus measures but more on that later.
Despite a dearth of reliable data concerning how long CPR should be performed for a patient’s optimal medical benefit, care providers may be stopping CPR efforts too early. The Lancet, a medical journal, released a study this week, examining CPR’s application time in hospital settings. They found that healthcare providers may be halting CPR too early, potentially depriving patients of additional critical incident recovery benefits.
It’s important to make two elemental observations about this study. The first concerns the centrality of the scientific method. Because human bodies are complex organic systems, anecdote can’t replace research rigor. Asking a surprisingly simple question—how long should CPR be performed to achieve optimal benefit with minimized risk?—becomes a complicated research process, aimed at delivering a reliable, scientific answer.
The second observation reveals just how seriously healthcare professionals take their patient care obligations. In a healthcare world focused on cost containment and financial performance, individual patients can get lost in the mix. This study shows us the lengths that clinicians and researchers are willing to go to save and extend human life.
The research study’s data was gathered in hospital settings. The organizations were participating in a standardization initiative, the American Heart Association’s Get with the Guidelines—Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation). Emergency heart function stoppage and resuscitation efforts were rigorously recorded, giving researchers over 64,000 cases, gathered over an eight year period at 435 hospitals, to analyze. A pattern emerged.
Even in hospital environments, care providers may have stopped CPR too early. Longer CPR, the study suggests, may improve reestablished circulation and increase positive hospital discharge rates.
Before going further, take a step back and pause. Consider the situation’s context. Having a heart attack in a hospital means that a patient is already hospitalized and, as a result, is at higher risk of dying, regardless of CPR length. The study found that, after a heart attack, half of the patients returned to spontaneous circulation while just over 15% survived to discharge. These figures don’t mean that the CPR technique is wrong, just that severely sick people in hospitals are at the end of their life’s journey regardless of how much time is spent on CPR.
The study’s findings will guide additional research and, I expect, will quickly work their way into first responder technique and first aid training. Unexpectedly, the CPR research project engages the national and state economic policy debate.
In Keynesian economics, a government’s infusion of borrowed money stimulates depressed consumer markets, countering recessionary impacts. The borrowing is then off-set by revenue generated in a restored, growing marketplace. Since governments act on different economic incentives than do individuals, broad market impacts can be achieved where an individual business might continue cutting spending, protecting its own short-term interests at the expense of long-term community stability.
For roughly the past 80 years, this economic policy prescription has been widely used. Critics tend to focus on government’s stimulus role, believing that Keynesian policy represents a philosophical overreach. The alternative, they argue, is a marketplace freed of noncommercial intrusion.
Most recently, the federal government, attempting to counter an expanding recession caused by the subprime mortgage industry’s collapse, took two actions. The first, bailing out the auto, banking and insurance industries, prevented market sector disaster through loans and grants allowing large automobile, banking and insurance companies to operate in a negative cash-flow period. The second step involved investing federal funds in physical public infrastructure projects, creating demand for the recession-decimated construction industry. The second step represents the stronger reliance on Keynesian economic theory.
Two questions arise. First, did the federal government initiative work? And, second, by extension, does Keynesian theory work?
The answer largely turns on philosophical grounds. Conservative policymakers argue that the entire effort was wrong headed; that the entire investment was misguided and wasteful. Progressive policymakers assert that not only did the initiative achieve a positive outcome by minimizing a collapsing marketplace’s chaos but that the stimulus investments were insufficient and inadequate to the challenge. In effect, the government policy stopped performing CPR too early.
Don’t abuse this analogy. The economy is not a hospitalized patient. The federal stimulus program is not CPR. Yet, national and state election debates turn on exactly this point. Economic policy does best when it facilitates the public good rather than protects and preserves individual advantage. Moving forward, the lesson is clear: don’t stop CPR too soon. Community prosperity creates individual prosperity.