Many accounts of shootings, often including those involving LEOs, report well-meaning bystanders’ performing CPR on the victims. Based on what I know about wounding mechanisms and physiology, though, I never understood why people did that other than the fact that they had no idea of what else to do and yet felt that they should do something. I’ve tried to confirm my belief regarding the matter and a few years ago asked the head of a major trauma center if CPR could help someone dying from a gunshot. He seemed strangely reticent to answer, but then said that CPR would be of no value.

Without getting into the details of why, that question has recently arisen in the news, and from what I can find, this quote sums up what knowledgeable physicians are answering:

“But when little or no blood remains in the circulatory system, as in massive hemorrhage caused by penetrating trauma, CPR (in the absence of rapid blood transfusion) just makes the situation worse.”

Unfortunately, some of those recent responses seem to be tinged with political overtones despite the fact that the question should be nothing more than a matter of sound medical practice.
So, my question for the membership is Does CPR help a victim of a penetrating gunshot wound who is bleeding to death? Please note that this question is for people who really know something about the matter and aren’t just guessing—or hoping.

Thanks for the knowledgeable responses.

quote:

Originally posted by sigfreund:
Many accounts of shootings, often including those involving LEOs, report well-meaning bystanders’ performing CPR on the victims. Based on what I know about wounding mechanisms and physiology, though, I never understood why people did that other than the fact that they had no idea of what else to do and yet felt that they should do something. I’ve tried to confirm my belief regarding the matter and a few years ago asked the head of a major trauma center if CPR could help someone dying from a gunshot. He seemed strangely reticent to answer, but then said that CPR would be of no value.

Without getting into the details of why, that question has recently arisen in the news, and from what I can find, this quote sums up what knowledgeable physicians are answering:

“But when little or no blood remains in the circulatory system, as in massive hemorrhage caused by penetrating trauma, CPR (in the absence of rapid blood transfusion) just makes the situation worse.”

Unfortunately, some of those recent responses seem to be tinged with political overtones despite the fact that the question should be nothing more than a matter of sound medical practice.
So, my question for the membership is Does CPR help a victim of a penetrating gunshot wound who is bleeding to death? Please note that this question is for people who really know something about the matter and aren’t just guessing—or hoping.

Thanks for the knowledgeable responses.

In the absence of a pulse with major hemorrhage in the field the person is dead.

If the victim has no heart beat and is not breathing, then CPR is a must, regardless of what else is wrong.

Now, if you start CPR and see a "pumper" bleed, then obviously you need to address that (or hopefully someone else) with direct pressure or a tourniquet to stop that bleed.

No O2 or blood to the brain you have maybe 5 min, tops. The Trauma guy is correct if you come upon a victim with a massive head injury or most of their insides are outside. I came up on a scene right after a truck ran over a guy on a bike, I got out to give aid until I saw the victim's brain was 2 feet from his head, no CPR would help that.

We have been trained to generally treat major bleeding ahead of CPR. Not much sense in pumping blood out of the heart if you're not going to get it back.

Without breathing, a person with all or no blood is dead. If you see a big bleed, plug/tourniquet quickly, but get the pump going ASAP.

A-Airway
B-Breathing
C-Circulation

Without those, regardless of what else is going on, the victim has four minutes at best.

Note: I'm not a doctor or medic, so this is based on my personal and professional first aid/first responder training, and my observations and discussions with those with greater training.


Civilian first aid hammers on the ABCs of CPR, and they're now ingrained in many people's heads.

The typical acronym, as pointed out by sns3guppy, is:
Airway
Breathing
Circulation

And the steps are processed in that order. That works well in typical civilian "unknown dying subject" situations, like a heart attack or choking, but not so well in a traumatic bleeding situation.

As a result, I can totally see why people would focus on the CPR because their minds are telling them that the person is dying, so the ABCs of CPR says that rescue breaths and chest compressions are the priority, instead of jumping to treating the other massive circulation problem (bleeding) that makes CPR pointless.

The military, on the other hand, apparently teaches a different acronym, likely because they're used to dealing with traumatic bleeding more often than something like a heart attack or choking. This is taught as either CABC or DABC. This stands for:

Deadly Bleeding/Catastrophic Hemorrhage
Airway
Breathing
Circulation

That would be the proper procedure for dealing with someone with massive bleeding. If you don't stop the rapid leaking, no amount of CPR will help. (And depending on how much leaking has already occurred, the subject may be past the point of CPR helping anyway due to insufficient blood volume/pressure, even if you do stop further leaking.)


Another common mnemomic is also reversed between civilian first aid and military/trauma first aid. The normal civilian version goes "Start the breathing, stop the bleeding, treat for shock", and you follow those steps in order. Whereas the military/trauma-focused version goes "Stop the bleeding, start the breathing, treat for shock".

This message has been edited. Last edited by: RogueJSK,

Okay.
Someone has a gunshot wound to the abdomen and has stopped breathing and has no pulse. We might assume that the lack of pulse is due to a coincidental heart attack, but far more likely it’s due to shutdown of circulation due to the damage caused by the gunshot. I realize it can’t hurt, but is CPR realistically of any value? What are compressions doing other than pushing the blood out of the body or into the abdominal cavity through the wound(s)?

(I’m not, BTW, asking about what other things might be appropriate, especially before it gets to that point. This is about CPR when circulation stops due to penetrating trauma. I am also not asking about CPR before breathing stops; every class I’ve taken for 30+ years said don’t do CPR if someone has a pulse and is breathing even if they’re unconscious.)

quote:

Originally posted by Southflorida-law:
If the victim has no heart beat and is not breathing, then CPR is a must, regardless of what else is wrong.

Now, if you start CPR and see a "pumper" bleed, then obviously you need to address that (or hopefully someone else) with direct pressure or a tourniquet to stop that bleed.

No O2 or blood to the brain you have maybe 5 min, tops...

agree.

airway

breathing

circulation - which would entail mitigating large blood loss as best as possible and chest compressions assuming the victim is not breathing

(EMT-B level + some Army training from way back)

-----------------------------------------------------

quote:

Originally posted by sigfreund:
Okay.
Someone has a gunshot wound to the abdomen and has stopped breathing and has no pulse. We might assume that the lack of pulse is due to a coincidental heart attack, but far more likely it’s due to shutdown of circulation due to the damage caused by the gunshot. Is CPR of any value?

of course. how many people are really good at checking a pulse anyway? Especially a 'weak and thready' pulse. not to be overly simplistic but this was hammered in to me:

you as a first responder are to stabilize as best as possible and RUSH the victim to REAL medical care as fast as possible

you are not an MD, not diagnosing, providing definitive care, figuring out what is REALLY wrong, NONE of that

just stick to the ABCs and get them evac'd ASAP using the best resources you can. the life-saving in the vast majority of cases happens at the ER or in the OR. not at at the site of the incident.

that's why personally I love it when I see cops scoop victims up and literally pile them into the back of a squad car and rush them to the ER full out

time matters more than technique.... (big one is c-spine of course but that's a whole other chapter). ABC then let the pros in the ER / OR handle it.

-----------------------------------

I have seen a person stabbed directly in the heart survive the injury (he died several days later) because of good CPR. He bled out but what little blood made it around kept him going until he got to the trauma bay. The trauma doc "clamshelled" him (split his chest open to get to the hole in his heart) right in the trauma bay. He fixed the hole and then pumped a metric ton of blood into him.

Trauma is easy:
Air goes in and out.
Blood goes round and round.
If the pt can't do those things, do it for them.
Plug the holes.

Anybody who is shot in the torso needs "bright lights and cold steel" more than anything you can do for them but CPR is what gives them a chance to get there. Don't diagnose "a lethal injury" and give up. Get to work.
If they aren't decapitated, start CPR.

Bruce

Most fire rescue departments no longer work/perform life saving efforts on people in traumatic asystole,(adults for the most part- depending on the situation of course like a massive triage, as we have limited resources and can only save/treat so many people at a time). Like others have said, without fluid that can remove/carry oxygen and other gases/nutrients to/from the body, the outlook is bleak. That doesn't mean we don't try certain things but just replacing volume/fluid without the other benefits previously stated, does not end well for the patient. Some departments are trying new things-carrying plasma/packed cells,etc., but it is difficult to regulate them, as far as, keeping them stable/viable for use in a pre-hospital setting in regular rescue trucks.

With that said, I have seen people live through many things you would not think possible. The human body is quite an amazing thing.

Is it worthless? I would say no but with obvious signs of death- decapitation, massive bleeding,etc., it seems a futile effort unfortunately.

I was an EMT in the military, national certified. But they taught us different than the civilian side.

Fix the holes first

Then
ABC

Rogue has it right

As a cop I’ve done cpr several times, but in all instances with GSW, the GSW was addressed first, then we proceeded in the normal fashion.

Per the TCCC, which seems to your scenario, the proper course of action is not ABC's, which hasn't been used in decades.

It is:
M-Massive hemorrhage
A-Airway
R-Respiration
C-Circulation
H-Hypothermia/shock

Pretty straight forward.

There are wounds that are survivable (with proper care) and those that are not. For the ones that aren't it won't matter what you do or if there is a trauma surgeon and surgery room right next to them in the field.

For the could have been survivable ones, leading causes of death are bleeding, airway, and tension pneumothorax at least according to modern battlefield stats.

So, slap a tourniquet on them if applicable. Otherwise plug the hole, get an airway via nasal pharangyeal if applicable and reduce the tension pneumothorax if that is developing.

Other than the blatantly obvious you can't know if their wound is survivable or not so you just treat as best you can until the pros get there. CPR if the have an airway but no heartbeat and not breathing. If they already bled out, well at least you tried.

I work in a neighborhood in DC that sees quite a lot of GSWs. Sometimes daily especially during the summer months, a lot of them fatal but the majority not. When we arrive onscene first we determine if the patient is even viable... numerous shot to the head or upper body, no pulse, not breathing, etc. My medics are really good about figuring things out quickly as we get lots of practice.

If someone is viable it makes no sense to be doing CPR if you don't control the bleeding first. You'll just be helping the blood to pump out faster.

Tourniquet if possible, pressure, occlusive dressing on the torso or quikclot.

As someone stated before I'm sure bystanders feel they want to help and CPR or putting pressure on a would is the only thing they're capable of doing as most probably don't walk around with a trauma kit. At the end of the day if someone is receiving CPR then they're already past the point of no return with those kind of injuries (I'm not talking about a heart attack, choking, etc).

Just 2 cents from someone who sees it regularly.

quote:

Originally posted by sooma:
Per the TCCC, which seems to your scenario, the proper course of action is not ABC's, which hasn't been used in decades.

It is:
M-Massive hemorrhage
A-Airway
R-Respiration
C-Circulation
H-Hypothermia/shock

Pretty straight forward.

Thank you for posting that. I was going too.

I'll also point out the current Army Combat Life Saver doesn't even teach CPR.

quote:

Per the TCCC, which seems to your scenario, the proper course of action is not ABC's, which hasn't been used in decades.

It is:
M-Massive hemorrhage
A-Airway
R-Respiration
C-Circulation
H-Hypothermia/shock

Pretty straight forward.

Actually, it is SMARCH, with the S meaning Safety: yours and the victim's. If you put yourself at risk and get wounded, the MARCH part will not come into play!

My limited experience has been that the CPR tends to pump the blood out of them until and unless the holes are plugged. Sometimes you don't even know how many there are until you get to pumping. The one I'm thinking of was likely shot directly in the heart with the first round and several of the more peripheral ones did not really bleed until compressions started.

Dear OP:

From what you see posted here if you have no medical equipment with you and you come across a GSW patient that fits the criteria for being dead you can start CPR and with a miracle you'll improve the situation. One thing to realize and this may seem obvious to most.... If CPR is being performed the patient is dead. No pulse, no breathing. They're dead. CPR is not performed on people that are alive.

SMARCH, MARCH whatever. It's really just another acronym for ABC but you're addressing something in a different order.

So, if I was not at work and was somewhere that people had been shot and had no signs of life the only way I'd be doing CPR on them were if they were family members or friends and even then it would obviously be futile but would definitely be the right thing to do.