Understanding CPR: What TV Doesn’t Show You

On television, CPR is dramatic but reliable. A character collapses. Someone rushes over, performs chest compressions — maybe a few shocks from a defibrillator — and within minutes, the patient gasps back to life. They are talking by the next scene, maybe cracking a joke from the hospital bed. Studies have found that CPR on television shows succeeds roughly 70% of the time.

The reality of CPR is profoundly different. Understanding what CPR actually involves — and what outcomes actually look like — is not meant to frighten you away from choosing it. It is meant to help you make a fully informed decision, one way or the other, when filling out your living will.

What CPR actually involves

Cardiopulmonary resuscitation (CPR) is an emergency procedure performed when someone’s heart stops beating (cardiac arrest) or they stop breathing. Modern CPR typically includes several components:

• Chest compressions: Pushing hard and fast on the center of the chest, compressing it at least two inches deep at a rate of 100-120 compressions per minute. This is physically forceful — broken ribs are common, particularly in elderly patients. Studies suggest rib fractures occur in 30% or more of CPR recipients.
• Defibrillation: Delivering electrical shocks to the heart to restore a normal rhythm. This is effective only for certain types of cardiac arrest (ventricular fibrillation and pulseless ventricular tachycardia) — not all.
• Medications: Drugs such as epinephrine are injected to stimulate heart activity and improve blood flow.
• Advanced airway management: This may include inserting a tube down the throat (intubation) and connecting the patient to a mechanical ventilator.

CPR is not gentle. It is a violent, aggressive intervention designed for a desperate situation. That does not make it wrong — but it is important to know what you are choosing.

The real success rates

Survival after CPR varies enormously depending on the circumstances. Context matters more than almost any other factor:

• In-hospital cardiac arrest (witnessed, with shockable rhythm): Survival to discharge ranges from about 25-40%. These are the best-case scenarios — the arrest happens in a monitored setting with trained staff and equipment immediately available.
• Out-of-hospital cardiac arrest: Overall survival to discharge is approximately 10-12%. For those who survive, a significant percentage have neurological impairment.
• Elderly patients with serious underlying conditions: Survival rates drop significantly. For nursing home residents, survival to discharge after CPR is estimated at 2-5%, and many of those who survive have significant functional decline.
• Patients with metastatic cancer or multi-organ failure: Survival is extremely low, and CPR in these situations often prolongs the dying process rather than restoring life.

These numbers are not meant to discourage you from choosing CPR. They are meant to help you understand that the decision is not as simple as “yes, save me” versus “no, let me die.” The appropriateness of CPR depends heavily on your overall health, the nature of your cardiac arrest, and what “survival” looks like in your specific situation.

What survival looks like

When we say someone “survived” CPR, that can mean very different things:

• Full recovery with no lasting effects — the best outcome, more common in younger, healthier patients with witnessed cardiac arrest
• Survival with some neurological impairment — memory problems, personality changes, reduced function
• Survival in a severely impaired state — dependence on machines, inability to communicate, persistent vegetative state
• Survival of the initial event but death during the subsequent hospitalization

Brain damage is a particular concern because the brain is extremely sensitive to oxygen deprivation. When the heart stops, blood flow to the brain ceases. Significant brain injury can occur within four to six minutes. Even when CPR restores circulation, the period without adequate blood flow may have already caused irreversible damage.

When CPR makes the most sense

CPR is most likely to be beneficial when:

• The patient is relatively healthy with a good baseline quality of life
• The cardiac arrest is witnessed and CPR begins immediately
• The underlying rhythm is shockable (ventricular fibrillation or pulseless V-tach)
• The arrest occurs in a hospital or other monitored setting
• The cause of the arrest is potentially reversible (heart attack, drug reaction, electrolyte imbalance)

When CPR may cause more harm than good

CPR may not be in a patient’s best interest when:

• The patient has a terminal illness that will lead to death regardless of resuscitation
• The patient has advanced dementia or is in a persistent vegetative state
• The patient has severe, irreversible multi-organ failure
• The patient has previously expressed that they would not want to survive with significant neurological impairment

In these situations, CPR may technically restart the heart, but it may also extend suffering without meaningful recovery. This is why physicians sometimes gently recommend a DNR order for patients with advanced illness — not because they are “giving up,” but because they want to ensure the patient’s remaining time is as comfortable as possible.

Making your decision

Your living will should address CPR directly. Here are some questions to consider:

1. If your heart stops and CPR has a reasonable chance of restoring you to your current quality of life, do you want it?
2. If CPR might save your life but leave you with significant brain damage, would you still want it?
3. If you have a terminal illness, do you want CPR attempted, knowing it may extend life but is unlikely to restore health?
4. Would you want a time-limited trial of CPR — for example, attempting resuscitation for a set period and then stopping if unsuccessful?

There are no right or wrong answers. Some people, fully informed of the risks, choose CPR in all circumstances — because they value any chance at continued life. Others decline CPR entirely, preferring to let a natural death occur. Many choose a middle path, wanting CPR in some circumstances but not others.

What matters is that your decision is informed, intentional, and clearly documented. The next time you watch a medical drama and see a patient bounce back from CPR, you will know the full picture — and your living will should reflect that understanding.