Would I really want CPR?
December 11, 2011 10:28 AM Subscribe
How long would I have to be dead (not breathing, whatever) before I would not want to be resuscitated with CPR?
After a certain amount of time some parts of my body would be irreparably damaged, no? So I'm thinking it (the CPR) has to happen right away, or forget about it.
After a certain amount of time some parts of my body would be irreparably damaged, no? So I'm thinking it (the CPR) has to happen right away, or forget about it.
You might not ever want it. Apparently many doctors do not.
posted by procrastination at 10:38 AM on December 11, 2011 [15 favorites]
posted by procrastination at 10:38 AM on December 11, 2011 [15 favorites]
So this answers your headline more than the rest of the question, but have you seen the article in this post? The comments in the post are interesting too, and relate to your question. You may think twice about wanting CPR at all, like, ever.
From the article:
"Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo."
posted by mireille at 10:39 AM on December 11, 2011
From the article:
"Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo."
posted by mireille at 10:39 AM on December 11, 2011
It also helps to by hyperthermic.
posted by le morte de bea arthur at 10:39 AM on December 11, 2011
posted by le morte de bea arthur at 10:39 AM on December 11, 2011
Hypothermia is your friend (or, not really, but it does have very occasional benefits). Norwegian woman Anna Bågenholm was revived after 80 minutes trapped under ice and made essentially a full recovery.
I hope this helps you in your planning.
posted by It's Never Lurgi at 10:40 AM on December 11, 2011 [5 favorites]
I hope this helps you in your planning.
posted by It's Never Lurgi at 10:40 AM on December 11, 2011 [5 favorites]
The reason a lot of doctors feel they wouldn't want CPR is that a condition likely to require CPR in a hospital setting is generally one where you're very very ill and are unlikely to see anything like a happy quality of life again.
I suspect most of them would be fine with CPR within a few minutes of drowning, however.
posted by le morte de bea arthur at 10:42 AM on December 11, 2011 [7 favorites]
I suspect most of them would be fine with CPR within a few minutes of drowning, however.
posted by le morte de bea arthur at 10:42 AM on December 11, 2011 [7 favorites]
I'm not sure if you're asking this because you're completed and Advance Directive and designating your resuscitation requests (what you would and would not want done for you) or because you're just curious?
After a certain amount of time some parts of my body would be irreparably damaged, no? That is true, but everyone is different. Working as a cardiac ICU nurse, I've seen multiple unwitnessed cardiac arrests where no one is truly aware of how long that person was down without a beating heart or active breathing, yet CPR/ACLS measures were taken on scene and in the ED, ultimately leading to someone surviving and returning to their neurological baseline. Neuro status upon recovery is always a crapshoot.
Most of the patients I work with who elect not to have any emergency measures taken DNR/DNI (or elect not to have chest compressions specifically) have chronic medical conditions that will eventually take their lives or are just > 70/80/90 years old and don't think they'll have a great quality of life after someone has pounded on their chest if they become drastically unstable while in the hospital.
posted by Asherah at 10:44 AM on December 11, 2011 [1 favorite]
After a certain amount of time some parts of my body would be irreparably damaged, no? That is true, but everyone is different. Working as a cardiac ICU nurse, I've seen multiple unwitnessed cardiac arrests where no one is truly aware of how long that person was down without a beating heart or active breathing, yet CPR/ACLS measures were taken on scene and in the ED, ultimately leading to someone surviving and returning to their neurological baseline. Neuro status upon recovery is always a crapshoot.
Most of the patients I work with who elect not to have any emergency measures taken DNR/DNI (or elect not to have chest compressions specifically) have chronic medical conditions that will eventually take their lives or are just > 70/80/90 years old and don't think they'll have a great quality of life after someone has pounded on their chest if they become drastically unstable while in the hospital.
posted by Asherah at 10:44 AM on December 11, 2011 [1 favorite]
I don't think there's a clearcut answer here: Man revived after 96 minutes.
That guy, whose voice you can hear in the radio story, sounds pretty good.
posted by purpleclover at 11:30 AM on December 11, 2011
That guy, whose voice you can hear in the radio story, sounds pretty good.
posted by purpleclover at 11:30 AM on December 11, 2011
It's actually not nearly as effective as it's made out to be. In the movies, if you get CPR, you survive, most of the time. In real life, if you're not in a hospital, the odds of you surviving a cardiac arrest after receiving CPR are something like 6% at best. That's just sheer survival. Many of those people will wind up with complications, which could range from something as "minor" as a cracked rib--which is pretty common, actually--to serious neurological complications.
I don't have any numbers here, but my intuition tells me that the people that do survive are young and otherwise healthy, and probably suffered either some trauma or were half drowned. Someone whose heart gives out either spontaneously or as the result of disease is way less likely to have a good result.
In the hospital, the survival rate goes up to 20-30%, but even then, "survival" may just mean "that wasn't the cardiac event that killed you, it was the one that happened two days later." The question "Why not just get it over with?" becomes a rational thing to ask.
posted by valkyryn at 2:00 PM on December 11, 2011 [1 favorite]
I don't have any numbers here, but my intuition tells me that the people that do survive are young and otherwise healthy, and probably suffered either some trauma or were half drowned. Someone whose heart gives out either spontaneously or as the result of disease is way less likely to have a good result.
In the hospital, the survival rate goes up to 20-30%, but even then, "survival" may just mean "that wasn't the cardiac event that killed you, it was the one that happened two days later." The question "Why not just get it over with?" becomes a rational thing to ask.
posted by valkyryn at 2:00 PM on December 11, 2011 [1 favorite]
Like others have said, it depends on why you need it. Drowning is different to cardiac arrest is different to overdoes is different to poison. It's more about what damage is done to your body than about what the CPR does.
posted by twirlypen at 2:23 PM on December 11, 2011
posted by twirlypen at 2:23 PM on December 11, 2011
As a nurse I see a lot of people who are still "full code" (i.e. they want CPR, intubation, everything to be done if their heart or breathing stops) who would almost certainly not survive those attempts. They're 90 years old, or they're 65 with COPD and diabetes and tons of other complications, or they're wasted away to almost nothing from cancer and its treatment. It's sad when somebody in that state does pass away in the hospital, because rather than going somewhat peacefully, they go in a flurry of invasive, violent, near-chaos as we do "everything" according to their wishes, even though the odds of it helping are practically nonexistent.
On the other hand, my dad had a sudden cardiac arrest in the home 5 years ago, and it was over 30 minutes between when he went down and when the EMTs were able to get a heart rhythm on him again. We were told he would not survive. After a week in the ICU he started to come out of the coma, and we were told that if he did survive he would likely have massive brain damage from the lack of oxygen, and never be able to care for himself. 6 months later he was home, and a year later he was basically the same, fully independent person he was prior to "the incident."
We attribute Dad's amazing outcome mostly to luck, and also to the induced hypothermia treatment he had in the hospital. (Hypo, not hyper! People who drown in icy water or are otherwise super cold when their heart stops tend to do a lot better, because it helps prevent the brain damage that would otherwise occur.) I've looked up the survival statistics for people who have an out-of-the-hospital cardiac arrest, and they're miniscule. But when it's you, or it's someone you love, the difference between 50% and 10% or even 0.1% odds doesn't matter. That person either survives, or doesn't, and you find yourself hoping to be one of the lucky ones. That's why I would never fault someone for wanting to be full code as long as they understand the long odds that are relevant to their situation.
All that said, it is generally accepted that irreversible brain damage begins to occur within 5-8 minutes of cardiac arrest. If you're worried about being revived but unable to return to the kind of life you were living, 5-8 minutes seems like a decent cutoff for "if they haven't started CPR yet, don't bother." But certainly there are people (like my dad) who survive and do fine even after longer, so it remains a really difficult question to answer.
posted by vytae at 2:36 PM on December 11, 2011 [1 favorite]
On the other hand, my dad had a sudden cardiac arrest in the home 5 years ago, and it was over 30 minutes between when he went down and when the EMTs were able to get a heart rhythm on him again. We were told he would not survive. After a week in the ICU he started to come out of the coma, and we were told that if he did survive he would likely have massive brain damage from the lack of oxygen, and never be able to care for himself. 6 months later he was home, and a year later he was basically the same, fully independent person he was prior to "the incident."
We attribute Dad's amazing outcome mostly to luck, and also to the induced hypothermia treatment he had in the hospital. (Hypo, not hyper! People who drown in icy water or are otherwise super cold when their heart stops tend to do a lot better, because it helps prevent the brain damage that would otherwise occur.) I've looked up the survival statistics for people who have an out-of-the-hospital cardiac arrest, and they're miniscule. But when it's you, or it's someone you love, the difference between 50% and 10% or even 0.1% odds doesn't matter. That person either survives, or doesn't, and you find yourself hoping to be one of the lucky ones. That's why I would never fault someone for wanting to be full code as long as they understand the long odds that are relevant to their situation.
All that said, it is generally accepted that irreversible brain damage begins to occur within 5-8 minutes of cardiac arrest. If you're worried about being revived but unable to return to the kind of life you were living, 5-8 minutes seems like a decent cutoff for "if they haven't started CPR yet, don't bother." But certainly there are people (like my dad) who survive and do fine even after longer, so it remains a really difficult question to answer.
posted by vytae at 2:36 PM on December 11, 2011 [1 favorite]
From the article:
"Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo."
posted by mireille at 1:39 PM on December 11 [+] [!]
Its worth pointing out that without a DNR (a signed, valid one) any tattoo, medallion, etc is pointless and worthless. As an EMT, if I'm called to a scene and you need CPR, you're getting it unless that DNR is in place. Also, while we might look for conventional medical alert jewelry, we're not gonna search your body on the off chance you've got a tattoo.
posted by blaneyphoto at 2:37 PM on December 11, 2011
"Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo."
posted by mireille at 1:39 PM on December 11 [+] [!]
Its worth pointing out that without a DNR (a signed, valid one) any tattoo, medallion, etc is pointless and worthless. As an EMT, if I'm called to a scene and you need CPR, you're getting it unless that DNR is in place. Also, while we might look for conventional medical alert jewelry, we're not gonna search your body on the off chance you've got a tattoo.
posted by blaneyphoto at 2:37 PM on December 11, 2011
On the other hand, my dad had a sudden cardiac arrest in the home 5 years ago, and it was over 30 minutes between when he went down and when the EMTs were able to get a heart rhythm on him again.
posted by vytae
Yep, totally possible. I've been the EMT in that situation. Its a longshot, but long down-times are sometimes survivable.
posted by blaneyphoto at 2:41 PM on December 11, 2011
posted by vytae
Yep, totally possible. I've been the EMT in that situation. Its a longshot, but long down-times are sometimes survivable.
posted by blaneyphoto at 2:41 PM on December 11, 2011
I was involved in a full code on an elderly man who did not start out in great shape. We got his heart beating again. I heard that the next day he regained consciousness for just a few minutes and was able to say goodbye to his family. Do you think that it was worth the violence we put his body through? That's something that only you can answer. And CPR is violent. It's a lot to put a body through.
CPR is usually a longshot and, as others have mentioned, success depends a lot on the circumstances. Last week, I saw CPR performed on a ~25 yr old drowning victim. He was probably down for 15 minutes. He is still in the hospital, but I hear his prognosis is good.
I've also seen young-to-middle-aged people have CPR started immediately after a cardiac arrest die anyway.
It really is a crapshoot that depends on a lot of factors that can't be anticipated. I think the answer to your question is that this question cannot be answered ahead of the time you would need CPR.
posted by kamikazegopher at 3:36 PM on December 11, 2011 [1 favorite]
CPR is usually a longshot and, as others have mentioned, success depends a lot on the circumstances. Last week, I saw CPR performed on a ~25 yr old drowning victim. He was probably down for 15 minutes. He is still in the hospital, but I hear his prognosis is good.
I've also seen young-to-middle-aged people have CPR started immediately after a cardiac arrest die anyway.
It really is a crapshoot that depends on a lot of factors that can't be anticipated. I think the answer to your question is that this question cannot be answered ahead of the time you would need CPR.
posted by kamikazegopher at 3:36 PM on December 11, 2011 [1 favorite]
One's sensitivity to oxygen deprivation from pulse cessation will vary depending upon their metabolic rate (which is one reason hypothermia helps prolong survival). Furthermore, one's ability to recover from brain damage will vary considerably based on their age. When the brain is young and still growing, it has a much greater ability to compensate for damage. The elderly brain, in contrast, has little plasticity and thus cannot easily reorganize itself after damage. In other words, brain damage and the effects thereof will not be equivalent (for a given time spent without pulse/oxygen) in all patient populations.
Regarding the violent nature of CPR: when I was trained, we were told that if you're not cracking ribs, you're not doing it right.
posted by dephlogisticated at 5:39 PM on December 11, 2011
Regarding the violent nature of CPR: when I was trained, we were told that if you're not cracking ribs, you're not doing it right.
posted by dephlogisticated at 5:39 PM on December 11, 2011
Part of the metric is http://en.wikipedia.org/wiki/Reperfusion_injury. A relatively new discovery, and seemingly the explanation for why hypothermia saves lives.
I am no medical ethicist, but I would prefer that all possible steps be taken in an emergency situation to bring me back. I want every chance of survival that's possible. If it doesn't work, I'm dead anyway. If it does work but I'm left brain-dead and sucking up resources, then the family can pull the plug if they want to. I think the odds of that happening are pretty slim, however. The odds of ending up dead, or alive in some meaningful way, are far greater.
posted by gjc at 6:06 AM on December 12, 2011
I am no medical ethicist, but I would prefer that all possible steps be taken in an emergency situation to bring me back. I want every chance of survival that's possible. If it doesn't work, I'm dead anyway. If it does work but I'm left brain-dead and sucking up resources, then the family can pull the plug if they want to. I think the odds of that happening are pretty slim, however. The odds of ending up dead, or alive in some meaningful way, are far greater.
posted by gjc at 6:06 AM on December 12, 2011
If it does work but I'm left brain-dead and sucking up resources, then the family can pull the plug if they want to. I think the odds of that happening are pretty slim, however. The odds of ending up dead, or alive in some meaningful way, are far greater.
I tend to reason the same way, but the sticky spot is in your phrase "alive in some meaningful way." It is possible for a person to be alive to the extent that you can't "pull the plug" - a person who can breathe on their own and whose heart continues to beat has no plug to pull, but they may not have any quality of life. If they're not with it enough to eat, then they'll require tube feedings, and withholding these is another version of "pulling the plug." But recall Terri Schiavo, and know that stopping tube feedings is considered by many people to be ethically unacceptable, compared to stopping a ventilator which might be ok. Another person might even be able to eat on their own, but unable to recognize loved ones, bathe independently, etc. In that case there's truly no plug to pull, and whether or not that person could be said to have any real quality of life is a very personal and difficult question.
Feelinggood, hopefully this discussion has given you some ideas to think about, though I'd imagine the answers are much less clear-cut than you had hoped for. One thing that might be useful is to consider whether you'd like to be kept alive on a ventilator, or with a feeding tube but unable to make your own decisions. These are situations in which it really could help your loved ones if you had a clear statement of "yes please keep me alive with these interventions" or "no, please don't continue to provide these interventions even if I will die without them." The question of whether you would want CPR in a given situation is based on conjecture about likely outcomes, but there are so many variables affecting those outcomes that it's practically impossible to make an informed plan. It's a lot easier to specify your wishes for what should be done once the outcome is known (needs a permanent ventilator, needs a permanent feeding tube, etc.). Or, if you're concerned about the possibility of living in a significantly diminished state even if you don't require a vent or feeding tube, perhaps a full DNR is the way to go.
If you do decide you would not want CPR, you will need to get your doctor to fill out a POLST form. This is the only document I know of that will prevent EMTs from providing CPR if your heart stops outside a medical facility, like at home or the grocery store. Even then, the form will only stop the EMTs if they know about it -- you should post a copy on your fridge, keep one in your wallet, and tell all your friends and family so that they can inform any emergency personnel who might be called. Like blaneyphoto said, EMTs aren't going to spend time searching to figure out whether they're supposed to do CPR, they're going to just start unless it is SUPER obvious that there is a doctor's order not to do so. Even your own wishes, communicated to your loved ones, won't count without that written doctor's order on the POLST form.
posted by vytae at 8:12 AM on December 12, 2011 [1 favorite]
I tend to reason the same way, but the sticky spot is in your phrase "alive in some meaningful way." It is possible for a person to be alive to the extent that you can't "pull the plug" - a person who can breathe on their own and whose heart continues to beat has no plug to pull, but they may not have any quality of life. If they're not with it enough to eat, then they'll require tube feedings, and withholding these is another version of "pulling the plug." But recall Terri Schiavo, and know that stopping tube feedings is considered by many people to be ethically unacceptable, compared to stopping a ventilator which might be ok. Another person might even be able to eat on their own, but unable to recognize loved ones, bathe independently, etc. In that case there's truly no plug to pull, and whether or not that person could be said to have any real quality of life is a very personal and difficult question.
Feelinggood, hopefully this discussion has given you some ideas to think about, though I'd imagine the answers are much less clear-cut than you had hoped for. One thing that might be useful is to consider whether you'd like to be kept alive on a ventilator, or with a feeding tube but unable to make your own decisions. These are situations in which it really could help your loved ones if you had a clear statement of "yes please keep me alive with these interventions" or "no, please don't continue to provide these interventions even if I will die without them." The question of whether you would want CPR in a given situation is based on conjecture about likely outcomes, but there are so many variables affecting those outcomes that it's practically impossible to make an informed plan. It's a lot easier to specify your wishes for what should be done once the outcome is known (needs a permanent ventilator, needs a permanent feeding tube, etc.). Or, if you're concerned about the possibility of living in a significantly diminished state even if you don't require a vent or feeding tube, perhaps a full DNR is the way to go.
If you do decide you would not want CPR, you will need to get your doctor to fill out a POLST form. This is the only document I know of that will prevent EMTs from providing CPR if your heart stops outside a medical facility, like at home or the grocery store. Even then, the form will only stop the EMTs if they know about it -- you should post a copy on your fridge, keep one in your wallet, and tell all your friends and family so that they can inform any emergency personnel who might be called. Like blaneyphoto said, EMTs aren't going to spend time searching to figure out whether they're supposed to do CPR, they're going to just start unless it is SUPER obvious that there is a doctor's order not to do so. Even your own wishes, communicated to your loved ones, won't count without that written doctor's order on the POLST form.
posted by vytae at 8:12 AM on December 12, 2011 [1 favorite]
I'm coming in late to say again that this is a murky question. Prolonged CPR Holds Benefits, a Study Shows. From the article:
The researchers initially thought they would find that some patients were being subjected to protracted resuscitation efforts in vain, said the senior author,Dr. Brahmajee Nallamothu, an associate professor at the University of Michigan and a cardiologist at the Ann Arbor VA Medical Center.posted by purpleclover at 9:30 PM on September 7, 2012
But as it turned out, those extra minutes made a positive difference. Patients in hospitals with the longest CPR efforts were 12 percent more likely to survive and go home from the hospital than those with the shortest times.
Dr. Nallamothu and his colleagues found that neurological function was similar, regardless of the duration of CPR.
This thread is closed to new comments.
posted by rtha at 10:30 AM on December 11, 2011