Is CPR Always Appropriate?
Rarely are there black and white answers about whether CPR is appropriate. The decision depends on many factors including the patient’s basic state of health, chances of recovery, will to live, and the benefits and burdens of further treatment.
You can talk with your health care team if you are unsure about the appropriateness of using CPR. They can give you information to help guide your decision.
As you think about CPR, your head as well as your heart will help you decide.
This information is a "starting place" for conversations among patients, families, and caregivers. It is a simple tool for talking with health care providers when a patient has very serious medical problems. Keep in mind that the best time to discuss these issues is before a crisis occurs.
Many People Ask
* "What happens when CPR is done?"
* "What are its benefits and burdens?"
* "Is CPR always appropriate?"
* "What happens if I don’t want CPR?"
Where Do You Turn For Answers?
Facing decisions about CPR can be terribly difficult. Often, it is a time of emotional confusion and suffering for families and caregivers, as well as for patients.
Your health care team can help you learn more about the benefits and burdens of CPR.
What is CPR?
CPR, which stands for cardiopulmonary resuscitation, is an attempt to re-start a patient’s heartbeat or natural breathing.
Questions About CPR
Decisions about CPR raise sensitive issues for many people. One way to begin thinking about these choices is by talking openly and asking questions with doctors and nurses, your family, your religious/spiritual counselors, and other members of your health care team.
How Does CPR Work?
The most common form of CPR uses "mouth to mouth" breathing to transfer oxygen and pressing on the patient’s chest to stimulate the patient’s lungs and heart. Trained personnel doing CPR can also use electric shock, airway tubes, fast-acting medications, and other procedures called "advanced cardiac life support."
What Are Some Benefits Of CPR?
CPR can be very helpful for patients who suffer a sudden accident and are otherwise healthy and expected to be able to regain physical and mental functioning.
What Are Some Burdens of CPR?
A person who is resuscitated may not be able to fully recover or resume previous activities. Resuscitation may have been too late, or the brain may have been without oxygen for so long that there will be serious, permanent nerve damage and/or mental impairment. Sometimes using CPR has other side effects, like broken ribs or damage to the windpipe, especially with the elderly. Many people who are already in very poor health do not want CPR to interrupt their natural dying process.
The following summaries are taken from medical journals. We encourage you to discuss these statements, and other viewpoints as well, with your health care providers.
CPR is appropriate and medically indicated for patients with reversible medical conditions who can be expected to return to a reasonably good quality of life.
Source: Hilberman M, Murphy D, J Clin Geriatrics 1997; 5:70.
Survival after CPR depends on the patient’s underlying state of health or illness. Patients with certain conditions or illnesses, such as metastatic cancer, acute stroke, sepsis, or pneumonia very rarely survive.
Source: Blackhall L, New Engl J Med 1987; 317:1281.
"Patients need to understand that CPR is often unsuccessful; about 15% of hospitalized patients on general medical or surgical floors on whom CPR is attempted survive."
Source: Emergency Cardiac Care Committee, American Heart Association, JAMA 1992; 268:2282.
The probability of an elderly, frail nursing home resident surviving CPR is approximately 1% and certainly no greater than 5%.
Source: Zweig S, Bioethics Forum 1998; 14(1) (Spring).
If a patient’s normal heartbeat stops and is not restored within 10 minutes, serious damage occurs to the brain and nervous system. After 15-20 minutes without a normal heartbeat, death is almost certain (except in cases of hypothermia).
Source: Scissors K, Clin Ethics Report 1993.
A patient with a CPR directive can still get needed treatment from "911" that is not related to CPR (for example, control of bleeding or pain medications). Emergency medical teams can also offer support to the family and will try to keep the patient comfortable.
Source: 6 CCR§1015-2, Colorado Regulations for CPR Directives.
Important Words To Know
"Do Not Resuscitate Order": A doctor’s order written in the patient’s medical chart, telling hospital or nursing home staff that the patient should not be resuscitated if (s)he has a cardiac arrest or stops breathing.
Ventilator: A machine (sometimes called a respirator) that pumps oxygen into and out of a patient’s airway and lungs. It is a mechanical substitute for normal breathing. A patient who survives CPR may have to depend on a ventilator for a short or long period of time.
Important Words Of Caution
CPR can truly be a lifesaving measure for an otherwise healthy person, but it can also be abused or "overdone" if the person receiving CPR is too sick or frail to recover.
Using CPR "successfully" to re-start breathing does not improve the patient’s basic health condition. CPR is often the first step down a long road. Once the patient starts breathing again, there can be complications and other choices to make.
Patients who do not want CPR should have a CPR or advance directive.
As You Think About CPR
You can take comfort in knowing you are not alone. Other people have had to make these important decisions. It may help you to keep these questions in mind:
* "What are our goals for medical treatment?"
* "How often should we re-evaluate using CPR?"
* "What would my loved one choose?"
Resources You Can Use
American Heart Association
(303) 369-5433 or (888) 302-8390
web site address: www.americanheart.org
Offers patients and families information and training on CPR. Supports and conducts research on diseases which affect the heart.
American Lung Association
(303) 388-4327 or (800) LUNG-USA
web site address: www.lungusa.org
Offers supportive assistance and information for persons with, or those who are interested in learning more about respiratory and lung disease.
National Hospice Organization
(800) 658-8898 or (703) 243-5900
web site address: www.nho.org
Promotes quality comfort care, pain relief, and emotional and spiritual support for dying patients and their families.
Alzheimer’s Association, Honolulu Chapter
(808) 591-2771
web site address: www.alz.org
Provides information, education, and support to patients and families about Alzheimer’s Disease and related dementias.
*Information on this page was created by and obtained with permission from the Colorado Collective for Medical Decisions, Inc. (CCMD), 1999, and Hospital Shared Services of Colorado.