Holland Kaplan, MD, assistant professor of clinical ethics and general internal medicine, Baylor College of Medicine, Houston. BCM.edu
CPR does save lives—but not as many as you might think. Outside the hospital, the survival rate for people receiving CPR is between 7% and 10%…in the hospital, it’s only slightly higher. CPR often results in broken ribs, punctured lungs, a cracked sternum and internal bleeding. It’s not uncommon for CPR survivors to experience personality changes, loss of speech, impaired cognition and loss of mobility. The liver, the heart and other organs also can suffer.
When to do CPR: If you have CPR training and see someone—a stranger or loved one—go into sudden cardiac arrest, you should try to save him/her. If you have information indicating that CPR would be inappropriate, such as a medical ID bracelet with a Do Not Resuscitate (DNR) indication, then don’t do CPR. But when you don’t know a patient’s medical conditions or preferences, err on the side of lifesaving treatment.
In the hospital, if your loved one has indicated that he/she would like to be resuscitated, doctors will attempt CPR while addressing the reason for the cardiac arrest. But when a patient is elderly, frail and has comorbidities, there may be a low chance of reviving him to anything but a further diminished state.
How to decide…
For yourself: Create an advance directive that outlines your choices for end-of-life care. If you are admitted to the hospital, doctors should ask your preferred code status—full code (attempt all resuscitation efforts) or DNR (do not resuscitate). But if a person’s code status is unknown, the default is to attempt to resuscitate all hospital patients.
For loved ones: If you find yourself having to choose between saying good-bye to a loved one and possibly putting him through a trauma that may make the situation worse, ask the doctor three questions—if CPR is attempted, what is the worst-case outcome…the best-case outcome…and the most likely outcome? The answers can help you make the best decision.