Do you want to be resuscitated? What you should think about.

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Do you want to be resuscitated? This is what you should think about before deciding

Barbara Jean Hayes, University of Melbourne, Joseph Ibrahim, Monash University

Summary: CPR is an important treatment. When used appropriately, it saves lives. But when applied injudiciously it can cause distress and avoidable harm.

Advance care planning is one way to start thinking about this long before a person is seriously ill. Particularly if you’re older and have chronic medical conditions, have that discussion with yourself, your loved ones and your medical team.

CPR may revive a heart that has stopped beating, but it doesn’t always restore a person back to a life they had or want. When CPR is performed on a patient who doesn’t want it, it disrupts a gentler dying process, transforming it into an impersonal medical event.

To save the patient’s life, medical and nursing staff will often administer cardiopulmonary resuscitation (CPR). CPR involves repeated chest compressions, artificial breathing, use of medications and an electric shock to jump-start the heart (defibrillation).

The aim is to restore a person’s heartbeat and blood pressure to normal, and in turn to restore life. CPR must be initiated quickly as brain cells rapidly die without blood and oxygen.

Patients admitted to hospital are often surprised when their doctors ask: “If your heart were to stop beating, would you want CPR or not?” But in every code blue doctors need answers to the same two questions. First, whether the clinical team considers CPR would be an effective treatment; and second, whether the patient wants CPR.

If a person has a cardiac arrest outside hospital, it is usual, and expected, that bystanders begin CPR, use a defibrillator if available, and call an ambulance.

In a hospital setting, though, the decision to administer CPR is built on a discussion around the patient’s medical condition and, importantly, takes into account their wishes.

CPR was developed and initially applied to resuscitate people with specific medical conditions such as a heart attack.

When a cardiac arrest occurs because of a heart attack or other heart condition, there’s a reasonable chance CPR will re-start the heart and save the person’s life.

Expanding the use of CPR more broadly to every disease that causes the heart to stop beating is not necessarily the case.

For older hospitalised patients (aged over 67 years in this research) with chronic diseases — such as heart failure, kidney disease, cancer or diabetes — their chance of surviving a cardiac arrest and leaving the hospital alive is around 11-15%. Chances of survival are slightly better in older patients without a chronic illness (17%).

For patients in the late stage of their life, due to advanced illness or severe frailty, their chance of survival is almost zero.

CPR is not always an appropriate treatment especially when it’s highly unlikely to restore a patient’s heartbeat.

Not every survivor of cardiac arrest returns to their previous level of functioning.

Patients may survive but with some brain damage.

CPR may revive a heart that has stopped beating, but it doesn’t always restore a person back to a life they had or want. When CPR is performed on a patient who doesn’t want it, it disrupts a gentler dying process, transforming it into an impersonal medical event.

In hospital, it’s routine to provide CPR for patients in cardiac arrest unless there is a medical order to withhold it, or if the patient has completed an advance care directive refusing CPR.

Avoiding harm from inappropriate or unwanted CPR requires planning ahead and being prepared to have a difficult conversation.

CPR is an important treatment. When used appropriately, it saves lives. But when applied injudiciously it can cause distress and avoidable harm.

Advance care planning is one way to start thinking about this long before a person is seriously ill. Particularly if you’re older and have chronic medical conditions, have that discussion with yourself, your loved ones and your medical team.

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