PALLIATIVE CARE COMMITTEE
CPR is Not Resuscitation Tara Shapiro, DO FAAEM
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o you want to be resuscitated? Should we really be saying this anymore? Is Cardiopulmonary Resuscitation (CPR) actually resuscitation if the survival rate is approximately 5% to 10% for out of hospital arrest and 24% for in hospital arrest?1 Resuscitation is the act of reviving someone from apparent death. CPR doesn’t really revive someone from apparent death very often. The general public believes CPR has a success rate of 53%-75%.2,3,4,5 Thank you, Hollywood! In medical dramas, return of spontaneous circulation occurred in 62% of patients. In addition, CPR on television does not adhere to published guidelines so individuals who watch these dramas regularly are more likely to have substandard knowledge of how to perform effective CPR.6
So what about the survivors of CPR? What does life really look like for the very few whose heart’s start again?
CPR is not resuscitation. All the other modality we do, such as IV fluids, defibrillation, antibiotics, IV pressures, and surgical procedures are all forms of resuscitation because they can actually change the course of a patient’s disease progression from badness or death towards improvement with a better chance than the mere 5-20% that CPR can. I encourage physicians to use more basic language that actually helps a patient or family make a well informed decision about their lives and health care.
survivors of CPR, cognitively impaired patients were not included in the data set and the review did not include a definition of QOL or what “good” or “acceptable” meant in relation to reported findings.12 Survivors of cardiac arrest might have sustained cognitive, emotional, and physical impairment which can reduce social participation, return to work, and adversely affect health-related quality of life.13
Instead of asking, “Do you want to be resuscitated?” maybe try saying things like, “If your heart stops and you are dead, would you want us to do chest compressions?” This is more descriptive and allows a patient to ask questions and consider options. You also will have the opportunity to ask patients and families what they know about the success rates of CPR before you tell them the real truth.
Again, I propose that CPR is not resuscitation. I believe we should stop asking the question, “Do you want to be resuscitated?” and replace this statement with questions that are more patient centered around their values while we give realistic expectations on what the road ahead will look like for an individual. Ask people what kind of lives they would value rather than asking “Do you want to be resuscitated?”
So what about the survivors of CPR? What does life really look like for the very few whose heart’s start again? If patients survived hospitalization to discharge, some studies report the quality of life for survivors of CPR was generally acceptable. However, they also described survivors’ experience of anxiety, depression, post-traumatic stress and cognitive dysfunction.7,8 I wonder if we are preparing families with realistic outcomes since approximately one in three admitted to intensive care will survive out of hospital cardiac arrest, but many of whom will need intensive, tailored rehabilitation after discharge.9
References 1. Vivian Lam, Cindy H Hsu. “Updates in Cardiac Arrest Resuscitation.” Emerg Med Clin North Am. 2020 Nov;38(4):755-769. doi: 10.1016/j. emc.2020.06.003. 2. Norkamari Shakira Bandolin, Weixiao Huang, Laurel Beckett, Garen Wintemute. “Perspectives of emergency department attendees on outcomes of resuscitation efforts: origins and impact on cardiopulmonary resuscitation preference.” Emerg Med J 2020 Oct;37(10):611-616. doi: 10.1136/emermed-2018-208084. 3. Lindsey Ouellette MPH, Amanda Puro MD, Jeffrey Weatherhead MD, Michael Shaheen MD, Todd Chassee MD, David Whalen MD, Jeffrey Jones MD. “Public knowledge and perceptions about cardiopulmonary resuscitation (CPR): Results of a multicenter survey.” Am J Emerg Med 2018 Oct;36(10):1900-1901. doi: 10.1016/j.ajem.2018.01.103. 4. Catherine A Marco, Gregory L Larkin. “Cardiopulmonary resuscitation: knowledge and opinions among the U.S. general public. State of the science-fiction.” Resuscitation 2008 Dec;79(3):490-8. doi: 10.1016/j. resuscitation.2008.07.013. >>
CPR also becomes less effective as people age. In those over the age of 80, successful CPR is associated with a risk of substantial functional decline.10 People needed daily help with ADLs and could no longer live independently. However, most studies were inconsistent and did not have uniform endpoints. Most in hospital cardiac arrests, found an increased risk of poor neurologic function at discharge, but the variables measured were not the same.11 In many studies that show good quality of life for
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