Photo from Wikipedia Commons
When I heard about Michael Jackson’s death I was shocked and saddened, as most music fans were. I prefer to remember him from his Off the Wall days, and it’s a record I listen to fairly regularly. But I wouldn’t have thought I’d be writing about his death on a nursing blog—until I heard the 911 call made from Jackson’s house before he died.
Apparently, Dr. Conrad Murray, a cardiologist trusted by Jackson, was administering chest compressions to Jackson on his bed—that is, on a soft, compliant surface that offers little resistance. This got me thinking. In hospitals, a backboard that’s attached to the crash cart is slid under a patient during cardiopulmonary resuscitation (CPR). The hard surface allows the compressions to be given deeply enough. And when someone collapses due to cardiac arrest in a public place, she or he is usually ends up on a hard surface like the floor. In all of the CPR certification classes I’ve taken, mannequins are on either the floor or a table—but no one has ever mentioned what to do if the victim is on a bed. Should you transfer the patient to the ground?
To clear up any doubts as to how important it is to have a noncompliant surface when administering basic life support, here’s an excerpt from the 2005 update of the American Heart Association guidelines:
“Effective” chest compressions are essential for providing blood flow during CPR. To give “effective” chest compressions, “push hard and push fast.” . . . Compress the adult chest at a rate of about 100 compressions per minute, with a compression depth of 1 to 2 inches (approximately 4 to 5 cm). . . . Allow the chest to recoil completely after each compression, and allow approximately equal compression and relaxation times. . . . To maximize the effectiveness of compressions, the victim should lie supine on a hard surface (e.g., backboard or floor), with the rescuer kneeling beside the victim’s thorax.”
A study published in the May 2009 issue of Resuscitation found that the depth of the compressions given to patients on mattresses can be overestimated. The authors concluded: “
Of course, we will never know whether the chest compressions Michael Jackson received were deep enough or whether deeper compressions might have saved him. But maybe this very public focus on CPR technique might help to save someone else.
Christine Moffa, MS, RN, clinical editor
There is also speculation (rumor? hearsay?–nothing real yet to report, as Janice notes above) that he was being put into a medically induced coma with the at night (the propofol the media have been going nuts over). If that’s true, and he wasn’t being monitored the whole time, that could also have been problematic. (Yes, I know–I should wait till the tox report is released!)
I believe that Jackson’s CPR was probably inadequate. Many health care providers perform CPR poorly, as several studies have pointed out, thus the requirement for periodic re-certification. Physicians, who are thought to self-police and are considered golden sources of revenue by hospitals, are usually not required to certify in BLS or ACLS.
MDs do not usually perform CPR, so this did not surprise me in teh least that CPR was performed incorrectly. I have even taken CPR classes with EMTs that did it wrong! We will never know what really happened with MJ and I wish people would stop speculating until the actual facts are released. Then they can have a field day. I am sure drugs will be involved. More education needs to be focused on prescription and OTC drug abuse. Especially tylenol which many deem safe to use and over-use.
Many who really need pain medication cannot get a prescription and when they do, they are woefully undermedicated. The MDs fear prescribing it to them, even to my hospice patients at end of life. Addicted patients know how to work the system and also buy them off the streets. But those in real need suffer.