May 29, 2023 from NPR
A recent incident at a senior living facility in California captured the nation’s attention when a nurse refused to perform CPR on an elderly woman in cardiac arrest, despite urgent pleas from a 911 dispatcher. The incident sparked controversy as it was revealed that the woman had expressed her desire to “die naturally and without any kind of life-prolonging intervention.” This highlights a widespread misconception about CPR and its limitations.
In 1878, researchers stumbled upon a breakthrough — chest compression could circulate blood during cardiac arrest, as evidenced by their experiments on cats. Fast forward to 1959, when pioneering researchers at Johns Hopkins successfully applied this method to humans. They excitedly declared that “Anyone, anywhere, can now initiate cardiac resuscitative procedures. All that is needed is two hands.”
CPR, while credited with saving numerous lives, carries a somber reality that many fail to grasp. Television portrayals often contribute to the misconception, with a study showing that the survival rate after CPR on television stands at 70%, leading people to believe that real-life rates exceed 75%. However, a comprehensive review of 79 studies revealed that the overall survival rate from out-of-hospital cardiac arrest remains stagnant at a meager 7.6% over three decades.
Survival rates vary with age and chronic illnesses, with patients in their 70s having a survival rate of 6.7%, dropping to a mere 2.4% for those over 90. CPR can also result in physical harm, including fractured ribs, internal bleeding, and broken sternums. Some patients who survive express regret and struggle to regain their previous level of functioning, with only 20-40% of older patients recovering their ability to function independently.
Brain injury is another significant concern, as the brain deteriorates rapidly when cardiac activity ceases. Even if the heart is successfully restarted, there is a considerable risk of irreversible brain damage, with approximately 30% of survivors experiencing significant neurological disabilities.
Considering the potential harm and the quality of life after CPR, it is crucial to carefully evaluate the trade-offs, potential complications, and long-term consequences in decision-making processes related to resuscitation efforts. Healthcare providers also face emotional distress and burnout from futile resuscitations, leading some to question the true purpose of CPR.
Physicians play a vital role in proactively helping patients navigate these choices. Education and effective communication are key, as studies show that patients often change their preferences after learning the true survival rates and witnessing the reality of CPR through videos. Initiating discussions on end-of-life care early, especially for the elderly or those with chronic conditions, allows patients’ wishes to be known in advance.
Using alternative phrasing, such as “allow natural death” instead of “do not resuscitate,” can empower patients and families in making decisions aligned with their values. Ultimately, physicians should guide patients in selecting interventions that may benefit them and decline those that may cause harm, always listening to and respecting patients’ preferences instead of rushing into action.
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