Damar Hamlin: The Exception, Not the Rule, in CPR

By Eleanor Tanno, M.D.

The world watched in real time the cardiac arrest and resuscitation of NFL player Damar Hamlin on the football field. In the moments that followed his collapse, the stadium grew silent and his teammates gathered closely in silent horror.

An attempt at cardiopulmonary resuscitation (CPR) is often like this. It is a nightmare from which it is hard to look away, and impossible to forget. In these moments, a person’s heart has stopped and blood flow with vital oxygen is not reaching the brain. Without restoring the blood flow, permanent brain damage sets in within a mere five minutes. A person’s life is on the line, and every second counts.

During CPR, electric shocks are administered in an attempt to restart a normal heartbeat. In the meantime, deep compressions are applied to the chest to manually pump the heart and force blood flow. A successful resuscitation is defined as restarting the heartbeat and restoring blood flow.

Believe it or not, Damar Hamlin was extremely lucky. His collapse was witnessed — so no time was wasted in coming to his aid. Additionally, professionally trained personnel immediately started CPR. An Automated External Defibrillator (AED) was available to provide the electric shocks needed to restart his heart. An ambulance was called without delay. Lastly, Hamlin was a young, healthy, athlete presumably without underlying health issues.

In other words, Hamlin was the ideal patient to have a cardiac arrest in the ideal situation. The only arguable improvement would have been if his cardiac arrest had occurred while already in a hospital.

For these reasons, Hamlin is in the extremely small 8%¹ of patients who suffer a cardiac arrest outside the hospital, receive CPR, and survive to leave the hospital. That means a whopping 92% of people who suffer a cardiac arrest outside the hospital do not live long enough to reach hospital discharge. Hamlin is the exception in CPR, not the rule.

As a primary care physician, I often discuss CPR with my patients who are planning their end-of-life wishes. I find there is a huge misconception about the success rate of an attempted resuscitation. Most tend to think CPR is usually successful.

Real resuscitations are messy. If a person collapses outside the hospital, they are lucky if a bystander witnesses the event and quickly calls 911. They are even luckier if that bystander is able to initiate CPR while awaiting the paramedics.

Once paramedics arrive, they continue CPR and transport the patient to the hospital. There, physicians work to figure out the cause of the cardiac arrest. At the time of the event, it is unknown why a person’s heart stopped. It could be an electric cardiac problem, as was the case with Hamlin. Among a large variety of reasons, the arrest could also be caused by a stroke, blood clot in the lungs, or severe electrolyte abnormality.

Even if the resuscitation is initiated for a patient already in the hospital, the event is distressing. Up to a dozen people may be involved. Depending on the patient’s expected chance of survival, the resuscitation attempt can go on for over an hour. Even in the hospital setting, the median survival rate to hospital discharge is only 18%².

If the resuscitation is indeed successful either inside or outside the hospital setting, physicians will then treat, when possible, the underlying cause. The patient remains at high risk for another cardiac arrest and, therefore, is treated in the Intensive Care Unit, often connected to a ventilator during this precarious time.

People tend to not only grossly overestimate the success rate of CPR, but also the quality of life following a successful resuscitation. Most of these patients are discharged to a rehabilitation facility and eventually still require long term living in a nursing facility.

Even previously-healthy Damar Hamlin spent a week in the ICU, several more days in the hospital and returned home to continue rehab. It is almost miraculous he has been cleared to return to professional football.

When I talk to my older and more chronically ill patients about their end-of-life wishes, I often include a discussion of CPR. Specifically, I ask, in the event of an unexpected cardiac arrest, would they want paramedics to attempt CPR? The alternative, would be to let nature run its course and to be left dead. Most will answer “of course I want CPR!” or “only if you think I can be saved,” which then leads to a conversation about the expectations of CPR.

A peaceful death at home, without an attempt at CPR, can be a blessing. This is especially true for people in their later years or in poor health. In a young patient like Damar Hamlin, an attempt at CPR is almost always appropriate. However, for most of us, we are the rule, not the exception in CPR.