You’re Critically Ill. Should Your Doctors Do CPR or Not?
You’ve seen it on TV. Someone’s heart stops. The ER team shouts “Clear!” One shock from the the paddles, and all’s well. But what happens in real life is often quite different.
You’ve seen it again and again on TV. Someone’s heart stops. The ER team shouts “Clear!” They apply the paddles. One shock, and the heart beats again. By episode’s end, the patient has fully recovered.
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But TV outcomes for cardiopulmonary resuscitation (CPR) are unrealistic. In a major study from a real-life hospital, just 18 percent of those resuscitated after cardiac arrest survived long enough to be discharged. And half of those survivors left with neurological (brain) damage.
That’s why it’s vital to talk to those you love while they’re still in good health about their end-of-life preferences. And to document their wishes in an advance directive (living will).
In reality, the success of CPR depends upon many factors, including your age, mental status and state of health, says Silvia Perez Protto, MD, Director of the Center for End of Life Care.
“If you’re young and healthy and your heart stops during surgery, chances are very good that CPR will bring you back successfully and return you to normal life,” she says.
“But if your heart or breathing stops and you have a severe, chronic condition, or you’re debilitated, or you already have brain damage, the odds that CPR can bring you back with normal brain function are very low.”
In the study mentioned above, resuscitation restored 30 percent of the young and healthy to normal function. In contrast, just 1 to 3 percent of the elderly and those with multiple medical problems were restored to normal function.
“CPR involves lots of intervention,” explains Dr. Perez Protto. It’s not uncommon to undergo chest compressions, have your heart shocked, receive intravenous medication and be placed on a mechanical ventilator, among other measures.
“When we can’t restore patients to a normal life, we don’t recommend doing all of this,” she says. The interventions may take a short — or a long — time. The length of time your brain is deprived of oxygen will have an enormous impact on your future quality of life.
In addition, the intervention itself may bring pain and distress.
“So if the heart is unlikely to come back, and chest compressions are likely to harm the body without the effect we hope for, we generally advise against CPR,” says Dr. Perez.
For patients unlikely to survive beyond six months, allowing their disease to run its course while keeping them comfortable allows for death with dignity, she says.
But everyone is different. Some patients who are unlikely to survive still want caregivers to do whatever it takes to keep them alive.
That’s why advance care planning and documenting each patient’s wishes in the medical record are so critical. They make both your family and your doctors feel confident that they’re following your wishes.
“Death is part of life,” says Dr. Perez Protto. “As they say, while death is inevitable, a bad death is not.”
TV may have colored your expectations about the success of interventions like CPR. Realizing what medical technology can — and can’t — do for you and those you love is vital to planning good end-of-life care.