The Muamba legacy: longer time spent on CPR?

Discussion in 'Current Affairs, News and Analysis' started by Grey_Mafia65, Mar 22, 2012.

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  1. One of the most astonishing things for me about the Fabrice Muamba story is the amount of time they actually spent administering CPR and delivering repeated defibrillation. Although I work in the NHS, I don't work in the area of Emergency Medicine so don't know the ins and outs but had thought the average time spent on resuscitation was around 20 minutes, although am aware that paramedics have to continue CPR until they've got a body to the hospital.

    The fact that Muamba was given CPR for so long and, from what has been said in the media, not suffered the sort of brain damage I was certainly expecting makes me wonder what the future holds in this regard.

    A brief chat with one of the neurosurgeons at work confirmed that CPR is never usually carried out to this extent and that the "value" of Muamba would have played a large part in it continuing. The question now is, if Joe Bloggs arrests and after CPR has been administered for 20 minutes, how can a doctor turn to the NOK and say "if we continue, the brain will have been starved of oxygen for so long there will be permanent brain damage if the patient does survive" when the NOK can then point the finger in Muamba's direction? Are protocols (with the potential spectre of families suing medics for not continuing treatment) going to have to be rewritten? And if protocols are extended to allow more time, what are the chances that we will have an increase in patients that do survive, but are brain damaged and then need medical treatment for the rest of their lives?
     
  2. Forastero

    Forastero LE Moderator

    I'm inclined to shove this in the med forum unless you specifically didn't post it in there?
     
  3. No, I specifically didn't post it there because I didn't just want a medical opinion. It would be interesting to hear from anyone with legal expertise to see where this could potentially lead.


    Editted to add: Or even just Joe Blogg's opinion. Would you want medics to continue working on your loved one with the inherent risks, having seen such a high profile survivor?
     
  4. Cause he's a Bolton player, they gave home a 50/50 drip with a mixture of special brew and frosty jacks (how it works up here).
     
  5. Oh dear, you may as well say 'compensation' three times and be done with it. I was told when I did first aid, St John's, that you continued until relieved by a competent authority. The implication being never say die, this does prove the point, but as you say opens a new can of worms.

    Since most people who stop breathing, accidents aside, would tend not to be the healthiest specimens, the chances of brain damage would be higher than a young top end athelete. With, presumably, matching close relatives who might get the money, but also get the survivor back. I don't think my ma would have been too happy if dad had just kept going in the state he was in when he snuffed it; the first 18 months wore her down, the same again would have pushed her into a care home.
     
  6. There was also a recent bit I read somewhere about people who dont know CPR just giving the heart massage and not worrying about the breathing as anything is better than nothing but I cant imagine one is better without the other.

    I am a lifeguard and we are taught to continue to perform CPR until an ambulance arrives, iteresting in the training it doesnt mention how many time you should try and defib someone, it always works first time in training so maybe in light of Muamba incident there will be a review of the process.

    Interesting point to watch this space.
     
  7. Did my Defib refresher trainng last month and the emphasis is now to keep pumping with occasional breaths, taking your que from the Defib itself. This case has reminded me, that it will not be a simple process. As I understand it, it was the early start of CPR that will prove the key to this guys recovery. I expect in years to come, this will be a quoted case for not stopping and even the Hospital teams will have try for longer.
     
  8. A brief chat with one of the neurosurgeons at work confirmed that CPR is never usually carried out to this extent and that the "value" of Muamba would have played a large part in it continuing.

    That galls me no end. I'll be frank, not so much in that you put a value on someone's life through their wealth (it's done everywhere from allowing people to have private medical treatment to deciding on transport safety legislation) but because you cannot convey you have the money to pay someone to actual carry on to the bitter end. You'd have to be blind not to see Muamba is "worth" something but unless I'm wearing a Patek and have a sign around my neck saying "I'll pay you each 5K if you keep trying and I live" you get treated like everyone else. Maybe I need a tattoo or have seen too many bad things done to relatives whose instant next port of call would have been a BUPA hospital if consultants hadn't bumped them off after deeming them too old to bother with. I wish I'd never asked "What and how much are you administering?"
     
  9. I read that one of the Spurs fans watching the match was a Cardiologist and he ran onto the pitch to help - do you think that had any impact on the decision to carry on?.

    There was some other analysis I saw (but cannot find now), that suggested he may not have flat-lined, but may have had some irregular heartbeat that they tried to shock him into getting it back to a more 'normal' beat.
     
  10. I'd give up resusing a 60 year old male smoker and drinker before giving up on a nipper

    The bloke is a prmiership football player in the prime of his life, fit and healthy in all respects ( cardiac issue accepted) why wouldn't you keep at it

    Obviously he had very good immediate access to advanced life support rather than fred blogs pounding his chest outside iceland on the highstreet and no doubt he had an immediately managed airway 02 and elecktrickery applied professionally at the earliest opportunity. His odds of getting to definitive medical care without brain damage were much higher than the norm
     
  11. I was given to understand that after 20 minutes of no output (at a medical facility), the general consensus was that the brain would be too oxygen-starved to not have suffered damage. Of course, all we know from the media (that I've heard at any rate) is that he is coherently talking, there's been no mention if he has any other functional disability.

    It's certainly telling that the neurosurgeon I was discussing this with referred to it as "a miracle". I suppose in time we will find out the facts, if there were any signs of output, etc. I predict a book at least in about a year's time. ;-)

    wm1965 - I know how you feel, and it was sort of the point of my post. I'd like to bet everything I own, if this had been a fan in the stands, copper, game official, etc, they would not have continued resus for as long as they did. Will medics be able to get away with having a cut-off time now though?
     

  12. Not sure about whether it was asystole (i.e. flat line) or an arythmia of some sort but witnessed arrest, people saw him go down and CPR started immediately would make a big difference. If O2 was immediately available it would have increased the effectiveness of the CPR. Plus the young man was very fit before the incident which also helps. A doc saying the time frame of CPR starting could affect the decision. Plus the young man was very very lucky.
     
  13. Makes you wonder how dead is dead, well at least for the 1st hour. Listening to the Bolton doctor who was with him on the pitch through to the hospital I got the impression that he thought he was a gonner.
     

  14. He's a zombie. Look at the facts. Dead for ages then with mysterious movements of the hands and administration of strange liquids he walks again?

    Zombie with out a doubt. :skull:
     
  15. OldSnowy

    OldSnowy LE Moderator Book Reviewer

    Did the fact that he had 100% O2 pumped into his lungs almost straightaway, rather than the 20% version we're used to, make a major difference?