By Jeremy Olson
Star Tribune
MINNEAPOLIS — Terasa Smith asked a crowd of educators in the New London-Spicer High School gymnasium last Tuesday if they could solve a mystery: Why don’t more people attempt CPR when it could save a life?
Only 43% of Americans attempted CPR last year when confronted with someone who collapsed from cardiac arrest — an often-fatal stoppage of the heart that cuts off blood flow to the brain and the rest of the body.
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“We see someone collapse. They’re unresponsive. Why are we not doing anything about it?” Smith asked the group.
It is a particularly vexing question in Minnesota, where only 39% of bystanders attempted CPR on people in cardiac arrest outside hospital settings last year. That was the fourth-worst rate among 20 states that submitted data to the national CARES registry.
Minnesota ranks among the best in its cardiac arrest survival rate, despite this lower rate of CPR, or cardiopulmonary resuscitation.
But some state emergency medical leaders suspect that Minnesotans’ cautious and reserved tendencies hold them back from attempting CPR, which is preventing the state from saving more lives.
CPR involves pressing on the chests of people in cardiac arrest, and sometimes breathing into their mouths, to keep blood and oxygen circulating through their bodies until their heartbeats are restored.
Every minute without CPR reduces the odds of survival by 7% to 10%, according to the American Heart Association.
“If you’ve got 10 to 12 minutes before the ambulance gets there, you need that bystander CPR,” said Dr. Pete Tanghe, an emergency room physician at North Memorial Health in Robbinsdale. “That bystander piece is critical.”
Most cardiac arrests outside of hospitals involve older people at home, which is why advocates recommend CPR training for anyone with loved ones who have cardiac risk factors. But they also occur in children and teens, sometimes triggered by athletic exertion.
Smith visited 26 schools last week as a coordinator for the state chapter of Project ADAM, which is supported by Children’s Minnesota and aims to reduce sudden cardiac deaths among children and teens. She also works at Children’s Minnesota as a cardiovascular technologist, where she recently implanted defibrillators in two high school athletes who collapsed playing sports.
New London- Spicer cleared the busy, back-to-school schedules of more than 200 staff members for the training, which included practice with inflatable mannequins and timed drills to see how quickly they initiated CPR and located external defibrillators in their schools.
Smith asked the crowd’s opinion on why more people don’t attempt CPR, and misheard the first shouted response.
“Beer?” she repeated, drawing laughter.
“No,” the teacher corrected her. “Fear!”
That made more sense, Smith said. Fear of doing CPR incorrectly or unnecessarily — or hurting someone lying motionless on the ground — probably explains why Americans don’t attempt the lifesaving procedure, she told the group.
“That’s a huge fear,” she said. “It’s a scary thing.”
That could be especially paralyzing in Minnesota, a reflection of the “Minnesota Nice” ethos. While there isn’t scientific proof, this tendency toward restraint could make some Minnesotans less likely to attempt CPR if they lack confidence, Tanghe said.
“There may be some cultural differences” that explain the state’s lower bystander CPR rate, said Tanghe, who also serves as a deputy director in the Minnesota Department of Emergency Medical Services.
“That’s something that the current CPR training needs to address,” he said, “that trepidation about what to do.”
Minnesota also is slightly behind the national average in using public external defibrillators, which are deployed in combination with CPR to detect heart stoppages and issue electrical shocks to try to restart the heart.
The comparative data has some margin for error; some states are more liberal than others in determining when bystanders attempt CPR or try to use defibrillators.
But Minnesota’s lower rate of bystander CPR has been consistent, year over year, in the annual registry, which was created by Emory University and the Centers for Disease Control and Prevention.
A low rate of bystander CPR could also speak to a fast emergency response in Minnesota. Paramedics might arrive at cardiac arrest scenes before bystanders react, said Lucinda Hodgson, a University of Minnesota researcher and coordinator of the state’s CARES data.
Yet there is little question that Minnesota needs to improve its rate, she said, “It’s like the number one thing we can do to save lives.”
The effect of Minnesota’s subpar bystander CPR rate is masked somewhat by other emergency response improvements, including the mobile deployment of heart-lung bypass machines that can maintain blood flow until doctors fix whatever caused patients’ hearts to stop.
Just over 12% of people who suffered cardiac arrests in Minnesota left hospitals alive last year, which was better than the national survival rate of 10.5%, according to the national CARES registry. The registry tracks outcomes of resuscitation attempts when people suffer cardiac arrests outside of hospitals.
State leaders said that success may have made Minnesota complacent when it comes to CPR, which can nearly double survival odds. CPR training has dramatically increased in other parts of the U.S., often after high-profile incidents such as the cardiac arrest of Buffalo Bills defensive back Damar Hamlin in 2023 during an NFL game.
Lawmakers responded to the concerns last year by requiring that Minnesota schools develop cardiac arrest response plans. Project ADAM has been flooded with training requests as school districts hustle to meet that requirement.
Joining Smith on Tuesday was Dr. Cheri Olson, a retired family physician from La Crescent, Minn., who survived a cardiac arrest that occurred without warning while she was treating a 98-year-old woman in her clinic. Quick CPR and a defibrillator shock saved her, she said.
“I was lucky because my brain was preserved,” Olson said. “The reason to do CPR is to save the most vital organ. A lot of people will say that’s the heart, but the most vital organ is the brain. If you save the brain, the heart will come along because we have other ways to get the heart going.”
She corrected the misconception among the teachers that they need to find that a person has no pulse before starting CPR. If people aren’t breathing and are unresponsive, that’s enough evidence to try CPR, she said. People who attempt CPR are protected from liability by state good Samaritan laws, she added, and should at least try.
“As a survivor of cardiac arrests,” she told them, “I will tell you that almost always something is better than nothing.”
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