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CPR/DNR: A Guide for Family Members

Most peoples’ understanding of Cardio Pulmonary Resuscitation or CPR is based on what they have seen on television or at the movies. A person collapses from a heart attack and a crash cart, led by doctors and nurses, comes rushing down the hall to bring the victim back to life.

This popular image has led many people to believe that CPR is used to save someone from dying, or to bring a person who has died back to life. This is not a completely accurate picture of CPR.

WHAT IS CPR?

CPR is an emergency method of life saving under certain limited circumstances, usually an event which causes the heart to stop beating in a person who otherwise has normally working organs such as the heart, kidneys, liver and brain.

If these organs are significantly damaged, the body cannot sustain itself and the heart stoppage is usually a result of the deterioration of the body in general.

CPR involves artificial respiration (breathing into the person’s mouth) and external heart massage, usually after a sudden event such as a cardiac arrest, drowning or high voltage electric shock in a body that is otherwise reasonably healthy. No matter what the cause, if the heart is stopped for too long permanent brain damage or death will occur.

HOW EFFECTIVE IS CPR?        

CPR’s effectiveness depends on the previous health of the person, the cause of the heart stoppage and the speed with which CPR can be administered. CPR is most effective if begun within a few minutes after a cardiac arrest and if there is follow-up care in a hospital intensive care unit. It is most successful when the victim is a reasonably healthy person who has had a sudden loss of normal heart function. In these situations, attempting CPR may be very worthwhile, with a survival rate ranging from 10 to 40 percent.

WHAT IS THE ROLE OF CPR IN A LONG-TERM CARE SETTING?

People who become patients and residents in long term care settings such as nursing homes, homes for aged and chronic care hospitals usually have many chronic health problems affecting many organs of the body including the heart, kidneys, liver and brain. Research and experience have shown that CPR is unlikely to have a positive outcome for most of these individuals, especially when they are also very elderly. When someone with many chronic health problems has a cardiac arrest, it is not an isolated event nor is it likely to be reversible. The cardiac arrest is usually part of a complex process. Many parts of the body are already affected by disease and a cardiac arrest is often the final step in a progressive and complex process of deterioration leading to death.

WHAT ARE THE CHANCES OF SURVIVING CARDIAC ARREST?

The odds of long term care residents and in-patients surviving a cardiac arrest are slight. Even under the best circumstances with the least compromised individuals, only 2 to 3 percent whose hearts stop suddenly survive after receiving CPR.   If there are pre-existing medical conditions, studies have shown that the likelihood of surviving CPR for those individuals is closer to zero.

WHY NOT TRY CPR ANYWAY?

If CPR were a simple, painless and dignified procedure that was readily available, there would be no reason to recommend against using it in the long term care setting. However, CPR requires intense treatment by doctors, nurses and other staff members, and the procedure itself may cause painful damage to the chest wall, ribs and internal organs.

CPR involves placing a person on a hard surface, either on a board if in bed or directly on the floor, pumping the chest vigorously and forcefully and at the same time breathing for the person. A breathing tube may be inserted into the windpipe and oxygen delivered to assist in breathing. In many cases, an intravenous line must be quickly inserted to deliver medications, and it is often necessary to apply a number of electrical shocks to the heart through paddles placed on the chest.

Some people residing in long term care settings respond at first to the CPR treatment. It is then usually necessary to transfer them to an intensive care unit at an acute care hospital to be maintained on a respirator. However, the vast majority of people who survive at first in these circumstances die within a few hours or days.

WHAT IS A DNR ORDER?

A DNR order will protect the person from unnecessary attempts at CPR which will offer virtually no medical benefit. When a person has agreed to a DNR order, this order is written into the health care record (the chart) by the physician. It tells the medical and nursing staff that, in the event of disorder affecting the heart such as a heart attack or other cause of cardiac arrest, certain resuscitative procedures are not to be started.

A DNR order applies only to the process of CPR and not to any other medical treatments. All other treatments can be considered and decisions about them will be made as usual, based on the person’s needs and interests and potential benefits.

 

References

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