How Johns Hopkins doctors helped bring CPR to the mainstream

Until 1960, the only way to treat cardiac arrest was for the surgeon to open a patient's chest and, holding the heart in his or her hands, squeeze blood to vital organs.

Then, a group of surgeons at Johns Hopkins forever changed the standard emergency room routine. The surgeons, who had also developed the external cardiac defibrillator, tried a new CPR technique called closed-chest cardiac massage—pumping the arrested heart without surgically opening the chest. They reported that they were able to successfully resuscitate every one of the first 20 patients they treated; 14 of those patients survived without brain damage.

Soon after the Johns Hopkins doctors reported their success, closed-chest cardiac massage crept into the mainstream, becoming the go-to procedure for all cardiac arrests in U.S. hospitals. A story on The Atlantic's website describes this "medical creep," a term for instances in which doctors use drugs, devices, or procedures approved by the Federal Drug Administration for a condition other than their intended use.

But the creep has a downside, notes author Brendan Reilly. In the initial study, Johns Hopkins researchers treated mostly young, healthy people whose hearts stopped during elective surgery. In more recent studies involving elderly patients, CPR survival rates are much lower and the procedure carries far more risks for long-term brain damage.

CPR creep reflects our failure to understand the difference between efficacy and effectiveness. The efficacy of a medical treatment refers to whether it can achieve its desired effect when studied under the ideal conditions of a research study. In contrast, the effectiveness of a medical treatment measures how well it performs in the "real world," where conditions are far from ideal.

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