Evaluating Cardiopulmonary Resuscitation in “The Pitt”: Accuracy, Clinical Realism, and Adherence to International Resuscitation Guidelines

Introduction Medical television dramas shape public perceptions of cardiopulmonary resuscitation (CPR). The Pitt has been praised for its clinical realism but has not been systematically evaluated. We assessed adherence of televised CPR to current European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines. Methods All cardiac arrest (CA) scenarios requiring chest compressions or defibrillation in seasons 1 & 2 (30 episodes) of The Pitt were prospectively analysed using a standardized assessment via an electronic case report form based on Utstein-style variables by at least 2 emergency and/or intensive care physicians experienced in CA management. Results Seventeen CA were identified. Most occurred in hospital (65%, n = 11/17) and had medical causes (59%, n = 10/17). ROSC was achieved in 56% (n = 9/16), and survival to discharge in 46% (n = 6/13). Key elements of the initial assessment, including consciousness and pulse checks, were fully guideline compliant, and correct hand placement was observed in 94% (n = 15/16). In contrast, guideline-compliant compression rate were achieved in only 19% (n = 3/16) of assessable cases, respectively, and pre-airway 30:2 compression-to-ventilation ratios were absent. Immediate post-shock rhythm reassessments were observed in 78% (n = 7/9) of appropriate cases. Nevertheless, no inappropriate shocks were delivered during asystole, and rhythm-based pharmacotherapy was appropriate, although medication timing and sequence could not be reliably assessed. Conclusion The Pitt provides a highly realistic portrayal of cardiac arrest, although manual CPR technique and some algorithmic details remain imperfect.