Advertisement

The next generation

      According to Mark Twain, “Truth is stranger than fiction”. He went on to say, “but it is because fiction is obliged to stick to possibilities; truth isn’t”.
      What, therefore, would he make of today's fiction? Are we looking at portrayals of the impossible or a glimpse of the future?
      Before we look at the future, it is worth considering how resuscitation is portrayed in the media at present. In a review of the lay press in the UK over a six month period in 2010, Field et al.
      • Field R.A.
      • Soar J.
      • Nolan J.P.
      • Perkins G.D.
      Epidemiology and outcome of cardiac arrests reported in the lay-press: an observational study.
      found that cardiac arrest was underreported in the newspapers with high survival rates. The average member of the public could therefore be forgiven for thinking that their survival is assured if they have a cardiac arrest.
      With regard to television and film, it would serve little dramatic purpose if the vast majority of victims died. In 1996, Diem et al.
      • Diem S.J.
      • Lantos J.D.
      • Tulsky J.A.
      Cardiopulmonary resuscitation on television: miracles and misinformation.
      watched all the episodes in one season of American series ER and Chicago Hope, as well as 50 consecutive episodes of Rescue 911. The survival rate was an astounding 77% with 67% surviving to hospital discharge. They commented that this might lead the viewing public to have an unrealistic impression of CPR and its chances of success. At a similar time, Gordon et al.
      • Gordon P.N.
      • Williamson S.
      • Lawler P.G.
      As seen on TV: observational study of cardiopulmonary resuscitation in British television medical dramas.
      performed an analysis of 64 episodes of three major British television medical dramas (Casualty, Cardiac Arrest, and Medics). They found a more realistic rate of survival (25%), although the victims were of a younger age group than would be expected in real life.
      Moving forward a decade, Wetsch et al.
      • Wetsch W.A.
      • Spelten O.
      • Marks J.
      • et al.
      An assessment of resuscitation quality in the TV drama emergency room: guideline non-compliance and low-quality CPR lead to a favourable outcome.
      reviewed episodes of ER between 2000 and 2010. Return of spontaneous circulation (ROSC) was achieved in 33.8% of cases, although the quality of CPR performed was often inadequate. In comparison, Harris and Willoughby
      • Harris D.
      • Willoughby H.
      Resuscitation on television: realistic or ridiculous? A qualitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama.
      reviewed 88 episodes of Casualty, Holby City, Grey's Anatomy and ER between 2008 and 2009. The immediate success rate was 46% with resuscitation attempts seemingly following contemporary guidelines. They commented that the lack of depiction of poorer medium to longer-term outcomes might give the public a falsely high expectation.
      In this issue, Mgbako et al.
      • Mgbako O.U.
      • Ha Y.P.
      • Gray H.H.
      • Ranard B.L.
      • Gray H.H.
      • et al.
      Defibrillation in the movies: a missed opportunity for public health education.
      studied the effect of defibrillation scenes in films from 2003 to 2012. They noted survival rates of 67% and also that defibrillation was used for an appropriate rhythm in only 28% of cases. They concluded that defibrillation and cardiac arrest survival outcomes lack accuracy in their portrayal and that this has a potential negative public health impact. There is a clear need for better public awareness and understanding of the correct use of defibrillators. Deakin et al.
      • Deakin C.D.
      • Shewry E.
      • Gray H.H.
      Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest.
      have shown that the presence of a nearby defibrillator does not guarantee its use and it is postulated that this is in part due to lack of awareness of their benefit.
      Also in this issue, Hörburger et al.
      • Hörburger D.
      • Haslinger J.
      • Bickel H.
      • et al.
      Where no guideline has gone before: retrospective analysis of resuscitation in the 24th century.
      provide an analysis of the practice of 23rd and 24th century medicine through the eyes of the American television franchise Star Trek. Whilst casually ignoring the classic (and, in this author's humble opinion, the best) era of the programme, they conclude that cardiac arrest is still prevalent in the future although more likely to be traumatic in origin. Ninety-six cardiac arrests were analysed, with the majority (95%) being witnessed. Tragically only 17 cases (18%) had any form of resuscitation performed although the success rate was excellent with 12 patients gaining ROSC and nine having a favourable neurological outcome.
      Some of the seemingly futuristic technologies used in Star Trek are fast becoming a reality. The needle-less transdermal injection, for example, is used in current medical practice. In 38% of cases, a remote hand-held scanner (‘Tricorder’) was used. This may seem like a futuristic device, but its reality may be closer than most realise. In January 2012, the Qualcomm Tricorder XPRIZE competition was launched with a $10 million prize on offer for the best developer of a medical ‘Tricorder’. Ten teams have been shortlisted and the winner will be announced in January 2016.
      Star Trek is not the only science fiction programme to portray resuscitation practice in the distant future. In the UK, ‘Doctor Who’ has been portraying conventional and futuristic approaches to resuscitation since it began in 1963. A significant proportion of these however seem to involve the ability of the title character to regenerate when in mortal peril. In an episode called “Curse of the Black Spot” in 2011, basic life support was portrayed on screen when the Doctor's companion successfully used CPR on her boyfriend, Rory. The resuscitation attempt lasted for 90 s, she used a compression to ventilation ratio of 5:1 and she spent a third of the time crying. But Rory lived!
      This may sound of little meaningful importance, but consider one thing. This episode was the 11th most watched programme on British television that week with 7.85 million viewers.

      Doctor Who Magazine 2011, 436:11 Panini Magazines.

      A significant proportion of these viewers were children. What if the resuscitation attempt had followed recognised guidelines and included the use of a defibrillator? The messages conveyed could have been even more powerful.
      The European Resuscitation Council has as one of its core aims the ambition that all children leave school knowing how to perform CPR and use an AED. This has formed the basis of its successful ‘Restart a Heart’ day in October of every year.
      • Lockey A.S.
      • European
      Restart a heart day.
      Any strategy that increases awareness amongst children of these vital skills should be encouraged. In particular, the impact of children watching their fictional heroes perform these skills accurately should not be underestimated.
      As for the future, maybe the possibilities posed by the fiction of the present are not beyond our grasp. We should certainly strive to develop and evaluate strategies dreamt up for television and film, although Time Lord regeneration energy may take a bit longer to develop. When this editorial is quoted at the ERC (Earth Resuscitation Council) conference in the 24th century, the same messages will presumably still apply. The media is a powerful tool for education, and contemporary fiction has the potential to be tomorrow's reality.

      Conflict of interest statement

      AL is fanatical about Doctor Who and would be delighted to offer expert advice to the production team. No other current or future conflicts declared.

      References

        • Field R.A.
        • Soar J.
        • Nolan J.P.
        • Perkins G.D.
        Epidemiology and outcome of cardiac arrests reported in the lay-press: an observational study.
        J R Soc Med. 2011; 104: 525-531
        • Diem S.J.
        • Lantos J.D.
        • Tulsky J.A.
        Cardiopulmonary resuscitation on television: miracles and misinformation.
        N Engl J Med. 1996; 334: 1578-1582
        • Gordon P.N.
        • Williamson S.
        • Lawler P.G.
        As seen on TV: observational study of cardiopulmonary resuscitation in British television medical dramas.
        BMJ. 1998; 317: 780-783
        • Wetsch W.A.
        • Spelten O.
        • Marks J.
        • et al.
        An assessment of resuscitation quality in the TV drama emergency room: guideline non-compliance and low-quality CPR lead to a favourable outcome.
        Resuscitation. 2012; 83: e111-e112
        • Harris D.
        • Willoughby H.
        Resuscitation on television: realistic or ridiculous? A qualitative observational analysis of the portrayal of cardiopulmonary resuscitation in television medical drama.
        Resuscitation. 2009; l80: 1275-1279
        • Mgbako O.U.
        • Ha Y.P.
        • Gray H.H.
        • Ranard B.L.
        • Gray H.H.
        • et al.
        Defibrillation in the movies: a missed opportunity for public health education.
        Resuscitation. 2014; 85: 1795-1798
        • Deakin C.D.
        • Shewry E.
        • Gray H.H.
        Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest.
        Heart. 2014; 100: 619-623
        • Hörburger D.
        • Haslinger J.
        • Bickel H.
        • et al.
        Where no guideline has gone before: retrospective analysis of resuscitation in the 24th century.
        Resuscitaiton. 2014; 85: 1790-1794
      1. Doctor Who Magazine 2011, 436:11 Panini Magazines.

        • Lockey A.S.
        • European
        Restart a heart day.
        Emerg Med J. 2014; 31: 696-697