On television, CPR is miraculously effective. Heroic chest thumping and electrical jolts restore young victims of shootings, car wrecks and near-drownings to normal, happy lives.

In the real world, though, cardiopulmonary resuscitation is usually done on old people with bad hearts. And most of the time, they die anyway.In a medical journal this week, three doctors contend TV's portrayal of CPR is bad medicine for the public.

The problem, they say, is that these hospital and rescue shows are so filled with seemingly authentic detail that people may think the portrayal of CPR is accurate, too. And this complicates the job of doctors who try to convince the terminally ill that they should forgo CPR if their hearts stop beating in the hospital.

"Our concern is the 85-year-old woman with breast cancer who may extrapolate what's happening on TV to her situation, although her chances of successful CPR are extraordinarily lower," said Dr. James A. Tulsky.

Tulsky and colleagues from the Veterans Administration and Duke University watched a season of "ER," "Chicago Hope" and "Rescue 911." They analyzed the shows' handling of CPR in an article in Thursday's New England Journal of Medicine.

They counted 60 cases of CPR on 97 programs. Among their conclusions:

- On TV, only 17 percent of people getting CPR were elderly. In reality, cardiac arrest is much more common in old people than in any other age group.

- On TV, three-quarters of the cases of cardiac arrest resulted from accidents, stabbings, lightning strikes and other non-cardiac disasters. In reality, between 75 percent and 95 percent are triggered by underlying heart disease.

- On TV, two-thirds of the CPR patients survived. In reality, survival is between 7 percent and 15 percent - and that's when patients' hearts stop beating in the hospital. When accident victims arrive in the emergency room in cardiac arrest, survival is close to zero.

Moreover, as dramatic as CPR looks on TV, the shows probably don't convey how gruesome this procedure can be.

"Resuscitation is an ugly thing," Tulsky said. "It's violent. It's not dignified. It may break bones in the chest. It is not the way we would envision that we would want to die."

Or perhaps survive, either. If the heart is restarted after it has been stopped too long, the victim may suffer permanent brain damage, a fate some would consider worse than death.

The report said TV producers have "a civic responsibility to be more accurate."

Dr. Neal A. Baer, an "ER" co-producer, countered in an editorial in the journal that there is no evidence watching these shows directly affects viewers' personal choices about CPR.

He said "ER" often depicts CPR in trauma cases because of its dramatic impact. "If we were to re-enact a minute-by-minute account of actual events in the emergency department," he said, "we would not have 35 million viewers each week."

Baer also noted that "Rescue 911," by its very nature, depicts amazing medical successes. "It is not, after all, called `Death 911,"' he said.

However, Dr. Gregory L. Henry, president of the American College of Emergency Physicians, said many people's unrealistic beliefs about CPR are a "tragic consequence" of television, especially when they blame doctors if their elderly relatives don't survive cardiac arrest.

"I'm not in the miracle business. I'm in the technical medical business," Henry said. "By and large, your death is pretty much predictable if you have cardiac arrest."