Realities of Cardiopulmonary Resuscitation

A new study in the Emergency Medical Journal, “Perspectives of emergency department attendees on outcomes of resuscitation efforts: origins and impact on cardiopulmonary resuscitation preference”, indicates that the success rate of CPR,  which is performed when a person’s heart has stopped or is no longer breathing, is vastly overrated by patients. In the study of emergency department patients and companions, about half said the success rate of CPR was greater than 75%, and nine out of 10 said they wanted to receive CPR if their heart stopped or they weren’t breathing. Yet, only 28% had discussed CPR with a doctor. Had they had such a discussion, they would have likely learned that the actual rate of survival is about 12% for cardiac arrests that occur outside hospitals and between 24% and 40% for arrests that happen in the hospital.

People also tend to discount potential negative effects CPR can have, the researchers said. These include:

1. Aspiration & Vomiting, which is the most frequent occurrence during CPR. 
2. Broken Ribs often occur which may lead to a damaged organ. They are quite painful.
3. Internal Brain Injuries can result from a loss of oxygen, leading to long-term health complications.
4. Aspiration Pneumonia can occur which can have long term consequences and potentially lead to death – even if the patient initially survives CPR.

Surviving patients may experience a significantly diminished quality of life. And, the near-death experience can lead to anxiety, stress and depression. 

When appropriate, doctors should discuss the process of CPR, its success rate, benefits and risks with patients and their loved ones, the study authors suggest. The authors argue that doctors should not assume that a patient or companion, even those with health care experience, will have realistic expectations about outcomes of CPR.

As the researchers wrote, “These findings should prompt emergency department physicians to initiate discussions about resuscitation with their patients while also providing them with key information to help facilitate informed decision-making”.  Preferably, these discussions will occur long before an ED admission and be done with a primary care physician, not during a crisis. 

We recommend that patients, particularly those in their 70’s and older or those with serious pre-existing conditions, consider initiating a discussion with their primary care physician about the benefits/burdens of CPR given their clinical situation. Perhaps in conjunction with the discussion about whether the patient is an appropriate candidate for CPR, the physician might also discuss whether a Do Not Resuscitate Order ought to be written, or if a Medical Orders for Life Sustaining Treatment, (MOLST) ought to be completed.  

Thanks,

David C. Leven                
Executive Director Emeritus and Senior Consultant