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CPR is Not the Best Thing To Do In Every Case – Newsletter 1-2-24

National Public Radio (NPR) has offered a lesser known perspective on cardiopulmonary resuscitation (CPR), suggesting that CPR can save lives, especially for the young and healthy, but can be futile and add pain and chaos to a frail, sick patient’s last moments. A NPR posting by emergency room physician Clayton Dalton observes that “Despite a common misperception that CPR can rescue almost anyone from the brink of death, most people that receive it don’t survive [and] of those that do, many sustain devastating neurological injury and may never wake up. CPR often causes additional injuries that can add pain and indignity to the final moments of life.” While there are many accounts of CPR bringing people back from near death due to injury, sudden heart problems, or other incidents, “CPR can cause bleeding in the lungs, lacerations to the liver, and fractured ribs or sternum,” according to Dalton, and “many survivors of CPR sustain damage to their brains, and may never be quite the same again. All of these outcomes become more likely with age, frailty, or chronic illness – and the likely harm of CPR may begin to outweigh its potential benefit.”

Older patients statistically do worse with CPR than younger patients. NPR cites a 2017 study of about 2,000 patients in Austria that found survival after cardiac arrest at 30 days was around 25% for patients under age 65, but only 4% for patients over 65. When the effects of diseases like heart failure, cancer, cirrhosis, or kidney failure are factored in, these patients are significantly less likely to survive after CPR. The cause of a cardiac crisis makes a difference too. Take the cases of ventricular tachycardia and fibrillation, which together cause about a third of cardiac arrests. These disturbances are the most likely to prove reversible, with one study showing survival as high as 35% in patients with a “shockable” rhythm but less than 2% in patients with a non-shockable rhythm. How do we know who will benefit, and who won’t? There is no one-size-fits-all answer to that. Should older persons consider “opting out” of receiving CPR if their overall health status means it might do more harm than good? That’s absolutely up to the individual. “By the time we’re in our seventies, or eighties, or nineties, the odds of CPR helping us get slimmer,” Dalton says. “If you hope for a gentler, quieter death at the end of your life, with minimal medical interventions, then CPR might not be for you.” But “if you value life above all else, then perhaps you may still opt for CPR, defibrillation, intubation, and everything else a hospital can do when your heart stops.” He says what’s critical is to “talk about these preferences early, or better yet, put them in writing [and] discuss them with your family.”

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