Controversy about Michael Jackson’s CPR and emergency care

Last week, the LA coroner’s office announced that they are treating the death of Michael Jackson as a homicide.

Apparently, lethal amounts of the anesthetic-sedative drug propofol and other drugs were found in Jackson’s body during autopsy. And Jackson’s personal physician Dr. Conrad Murray is the focus of the investigation.

Murray was also criticized about his delivery of emergency care to his celebrity patient. Here are some of the questions that have come up:

Did Murray perform CPR properly?

CPR, short for cardiopulmonary resuscitation is performed when a person suffers from cardiopulmonary/cardiac arrest, e.g. the victim stops breathing and/or the heart stops beating. (Possible causes of the cardiac arrest have been discussed in a previous post). CPR, which consists of rescue breathing and chest compressions, is applied immediately after collapse to keep the blood circulating to the brain while waiting for emergency services to arrive. Murray reportedly found Jackson in his bed with a weak pulse and immediately started CPR. Many people questioned the effectiveness of performing CPR chest compressions on a bed/mattress. It is recommended that CPR works best when a patient is lying on a hard, flat surface such as the floor. Should the doctor have moved Jackson to the floor before starting CPR?

Was there an AED in the house?

CPR alone cannot restart the heart. It needs an electric shock from a defibrillator to make beat again and this has to be done within 7 minutes of collapse, even with CPR before permanent brain damage and death occurs. Without CPR, this window of opportunity becomes shorter. Portable defibrillators, called automated external defibrillators (AEDs) are easily available and can be used even by laypersons. Could an AED have saved Jackson’s life?

Why did it take so long for the doctor to call 911?

The survival rate among cardiac arrest victims is very low. Every second counts if death is to be prevented. CPR alone cannot save a life. An AED within public access or by emergency medical services (EMS) is needed within the shortest time possible to restart the heart and the blood supply to the brain. CPR can minimize brain damage and extend the window of opportunity to save the victim’s life until professional emergency help comes. Unfortunately, it is unclear when the cardiac arrest happened and when the 911 call was made. It also reportedly took 25 to 30 minutes between the 911 call and the arrival of the paramedics. By then it was too late to save the King of Pop. So the next question is:

Why did it take so long for the EMS to arrive?

Photo credits: wikicommons