CPR or cardiopulmonary resuscitation used to be very simple to understand. Cardio stands for heart, pulmonary stands for lungs and resuscitation means to revive from death. When a patient died, someone would push on the person’s chest to try to restart the heart while giving mouth-to-mouth resuscitation to help the person breathe.
Over time, CPR has become more complex as healthcare professionals have discovered advanced ways to try to bring the person back to life. The patient may now be given medications, his heart may be electrically shocked with paddles placed on the chest, and he may be placed on a ventilator to help him breathe. What seemed like an easy question, “Does the person want CPR?” has turned into a more complicated decision. What do you need to know to make a good decision?
1. Make sure you really understand what really happens during CPR. In the past, doctors only used CPR on patients who were having a heart attack and might benefit from receiving CPR. Now we use it for everyone, including those in a terminal state, whether it will work or not. When I ask people, “What is CPR?” they say it is when someone pushes on their chest or shocks them with paddles. Most people do not realize they will be put on a breathing machine which they may have to stay on for the rest of their lives.??Tip: Ask your doctor to describe exactly what will be done to you during CPR.
2. CPR doesn’t work like you see on television. I’ve asked many groups of healthcare professionals, “How many of you would like to die by CPR?” No one ever, ever raises a hand. What is it that they know that they’re not telling us? They know that the chance of CPR working is minimal, sometimes even 0 percent. On shows like ER, CPR brings the patient back to life about 75 percent of the time (Diem, Lantos and Tulsky 1996), when in real life it only works, at best, 17 percent of the time for those who are healthy (Peberdy, et al. 2003). In situations where someone is seriously ill and in the intensive care unit, the chance of success may be as low as zero percent. ??Tip: Ask your doctor about the “real” chance of CPR bringing you back to life.
3. CPR isn’t going to make you better and it might make you much worse. When the healthcare team is pushing on the person’s chest, there is a chance of broken ribs or a collapsed lung. In addition, the longer the patient isn’t able to breathe, the greater the chance for brain damage. ??Television misleads you by letting you think a person will be healthy enough to go home about 67 percent of the time (Diem, Lantos and Tulsky 1996). In reality, if CPR is able to bring the patient back to life, the chance of this person going home with good brain function is about 7 percent (Kaldjian, et al. 2009). For others, they may survive CPR but they won’t be able to leave the hospital.??Tip: Ask your doctor about what kind of life you might have after CPR.
4. Think about the kind of death you are choosing. With CPR, you might not have the opportunity for a peaceful and profound death experience. When you picture the last minutes of your loved one’s life, do you see strangers straddling the patient on a bed, pushing on the patient’s chest, while the family waits outside in the waiting room? Or do you see a time with family and friends gathered around the bedside, with words of love being expressed, music being played or prayers being said? ??The CPR decision is about more than medicine. It frames the dying experience for the patient and the loved ones. I would encourage people to balance the chance of CPR working and bringing the person back in a good condition with the desire for a good, peaceful and dignified death. This is why healthcare professionals wouldn’t want to die by CPR; there is nothing peaceful or dignified about this type of death. ??Tip: Ask your doctor if your loved ones could be in the room with you during CPR so they could say their goodbyes.
5. The decision about CPR is only one part of a good end-of-life plan. It is important to put the act of CPR into the context of this person’s life. The following questions are just as important as, “Do you want CPR?”??Where would the person want to die??Whom would the person want to be with as he or she dies??What would bring peace and comfort during the dying process??For many people, CPR just prolongs the dying process, is this okay???I am not saying that people shouldn’t choose to attempt CPR; I just want patients and their loved ones to have the facts about CPR. Talk to your doctor and take the time to make wise and informed decisions for yourself and for those in your care.
References: Diem, S. J., J. D. Lantos, and J. A. Tulsky. 1996. Cardiopulmonary resuscitationcon television: Miracles and misinformation. New England Journal of Medicine 334 (24): 1578–82.??Kaldjian, L.C., Z.D. Erekson, T.H. Haberle, et al. 2009. Code status discussion and goals of care among hospitalized adults. Journal of Medical Ethics 35 (6): 338–42.??Peberdy, M.A., W. Kaye, J.P. Ornato, et al. 2003. Cardiopulmonary resuscitation of adults in the hospital: A report of 14,720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 58 (3): 297–308.
Viki Kind is a clinical bioethicist, medical educator and hospice volunteer.