Resuscitation on television: Realistic or ridiculous? A quantitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama

Abstract

Introduction

Patients’ preferences for cardiopulmonary resuscitation (CPR) relate to their perception about the likelihood of success of the procedure. There is evidence that the lay public largely base their perceptions about CPR on their experience of the portrayal of CPR in the media. The medical profession has generally been critical of the portrayal of CPR on medical drama programmes although there is no recent evidence to support such views.

Objective

To compare the patient characteristics, cause and success rates of cardiopulmonary resuscitation (CPR) on medical television drama with published resuscitation statistics.

Design

Observational study.

Method

88 episodes of television medical drama were reviewed (26 episodes of Casualty, Casualty, 25 episodes of Holby City, 23 episodes of Grey's Anatomy and 14 episodes of ER) screened between July 2008 and April 2009. The patient's age and sex, medical history, presumed cause of arrest, use of CPR and immediate and long term survival rate were recorded.

Main outcome measures

Immediate survival and survival to discharge following CPR.

Results

There were a total of 76 cardio-respiratory arrests and 70 resuscitation attempts in the episodes reviewed. The immediate success rate (46%) did not differ significantly from published real life figures (p = 0.48). The resuscitation process appeared to follow current guidelines. Survival (or not) to discharge was rarely shown. The average age of patients was 36 years and contrary to reality there was not an age related difference in likely success of CPR in patients less than 65 compared with those 65 and over (p = 0.72). The most common cause of cardiac arrest was trauma with only a minor proportion of arrests due to cardio-respiratory causes such as myocardial infarction.

Conclusions

Whilst the immediate success rate of CPR in medical television drama does not significantly differ from reality the lack of depiction of poorer medium to long term outcomes may give a falsely high expectation to the lay public. Equally the lay public may perceive that the incidence and likely success of CPR is equal across all age groups.

Introduction

Patients’ preferences for cardiopulmonary resuscitation (CPR) appear to relate to their perception of the likelihood of success of the procedure: if patients understand the “real” likelihood of success they are far less likely to request it.1, 2 Many studies have demonstrated that the general public have a poor knowledge of cardiopulmonary resuscitation outcomes and often grossly overestimate the likely success, in some cases overestimating the probability of survival to discharge by more than 200%.3, 4, 5

There is further evidence that the lay public largely base their perceptions about CPR on their experience of the depiction of CPR in the media3, 5, 6, 7, 8, 9 which has led to criticism by the medical profession of the portrayal of cardiopulmonary resuscitation on programmes such as ER, Casualty and Holby City.10, 11, 12 Medical television drama programmes such as Casualty are often screened on prime-time television, Casualty for example at 8 pm on Saturday evening.

Historically, doctors have only involved 6–10% of patients and 36–84% of patient's families or carers in discussions when “do not attempt resuscitation” decisions have been made.13, 14 Whilst the relative benefits and burdens of discussing resuscitation decisions with patients has been controversial15, 16, 17, 18, 19 it is becoming increasingly encouraged,²⁰ particularly with introduction of the Mental Capacity Act 2005 and other recent developments to proactively involve patients in advance statements and advance decisions to refuse treatment.²¹ Recent research has indicated that the majority of patients do wish to be involved in end of life decisions such as resuscitation and would also wish their relatives to be involved should they become unable to competently participate in such discussions.4, 22

In order for patients and their relatives to have informed discussions about CPR with medical professionals they need to have a realistic understanding of the procedure, its risk and the probability of likely benefits. As television media may potentially influence the perceptions of the general public about CPR, we sought to appraise the depiction of CPR in prime-time medical television drama and review not only the survival rates these programmes depict but also the demographics of the patients who are resuscitated and the underlying causes of cardio-respiratory arrest. Earlier research (now over 10 years old) has found variable “realism” of television resuscitation although the majority of television dramas previously studied no longer exist.6, 23

In reality, immediate survival following cardiopulmonary resuscitation in hospital is on average around 40–47% with 10–21% surviving to discharge.9, 24, 25, 26, 27, 28 For out-of-hospital arrests immediate survival is around 26.8% with survival to discharge hospital 13.7%.9, 24, 25 These figures represent published results of all arrests grouped together, in certain groups the survival rates may be even lower e.g. for patients whose initial rhythm was not ventricular tachycardia (VT) or ventricular fibrillation (VF) immediate survival is reported to be around 37% with survival to discharge only 6.2%.²⁴