What do you know about CPR?

[clifffaith]

There’s a whole bunch of us at the Old Folks Home semi freaked out about CPR after attending Friday’s lecture on advance directives. Doctor gave her spiel about having paperwork with your wishes known. We filled out paperwork as part of moving in here, so we figured we had ourselves covered. We had indicated we want no extraordinary measures, but sure, do CPR. Then she made more detailed comments about DNRs and CPR and I was like “wait, what?!” Turns out CPR is right up there with intubation and feeding tubes and other things one may not want for themselves and loved ones. Here we are thinking CPR is a “normal medical procedure” like they do on most episodes of Grey’s Anatomy. On the contrary the success rate is very low even in the hospital and the negative after effects can be severe. I immediately came home and started googling and found this article. Very eye opening!

https://www.npr.org/sections/health...-may-be-preferable-for-many-than-enduring-cpr

Then I talked to my 90 year old mother who seemed to be clued in about CPR and not wanting it. And she was freaked out I would have let EMTs do CPR on her if she passed out on the kitchen floor. Mom, I had no inkling whatsoever that CPR was against your wishes if you had otherwise been up walking around minutes before!

After thinking about it more, Cliff decided he DOES want CPR. Well, good thing he confirmed this because between being 86, having bladder cancer and not knowing what day of the week it is, I figure he’s out of warranty!

 

[DeniseM]

Our advanced directive says the following:

I do not want my life to be prolonged if I have an incurable and irreversible condition that will result in my death in a relatively short time. I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or the likely risks and burdens of treatment would outweigh the the expected benefits.

Our attorney said that the wordage above does not preclude CPR or the use of defibrillators, etc.

 

[ScoopKona]

I know that CPR is very, very, very strenuous exercise. They made us perform it on a dummy for 10 minutes to get a Rescue Diver card. My arms were on fire and my back felt like an overwound clock.

 

[geist1223]

Just because CPR may restore breathing and heart beat does not mean there is no severe irreparable damage to the Brain or other parts of the body.

 

[dougp26364]

Our advanced directive says the following:

I do not want my life to be prolonged if I have an incurable and irreversible condition that will result in my death in a relatively short time. I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or the likely risks and burdens of treatment would outweigh the the expected benefits.

Our attorney said that the wordage above does not preclude CPR or the use of defibrillators, etc.

I can tell you from working 31 years in a hospital, that wording is so vague when it comes to medicine that everything will be done first, and then the family will need to make a decision to continue, or not continue, medical care. At that point most family members feel they are being asked to pull the plug and are terrified to do so.

Depending on the hospital, even a DNR or Do Not Resuscitate order could mean you’ll end up on life saving/extending therapy such as intubation and on a ventilator. Some doctors interpret a DNR to only mean the creation of a heart beat but, if you stop breathing intubation and a ventilator are treatment.

There should be no vague statements such as “a short time” as the definition could be from a week to a month to a few years.

 

[davidvel]

There’s a whole bunch of us at the Old Folks Home semi freaked out about CPR after attending Friday’s lecture on advance directives. Doctor gave her spiel about having paperwork with your wishes known. We filled out paperwork as part of moving in here, so we figured we had ourselves covered. We had indicated we want no extraordinary measures, but sure, do CPR. Then she made more detailed comments about DNRs and CPR and I was like “wait, what?!” Turns out CPR is right up there with intubation and feeding tubes and other things one may not want for themselves and loved ones. Here we are thinking CPR is a “normal medical procedure” like they do on most episodes of Grey’s Anatomy. On the contrary the success rate is very low even in the hospital and the negative after effects can be severe. I immediately came home and started googling and found this article. Very eye opening!

https://www.npr.org/sections/health...-may-be-preferable-for-many-than-enduring-cpr

Then I talked to my 90 year old mother who seemed to be clued in about CPR and not wanting it. And she was freaked out I would have let EMTs do CPR on her if she passed out on the kitchen floor. Mom, I had no inkling whatsoever that CPR was against your wishes if you had otherwise been up walking around minutes before!

After thinking about it more, Cliff decided he DOES want CPR. Well, good thing he confirmed this because between being 86, having bladder cancer and not knowing what day of the week it is, I figure he’s out of warranty!

As you note, CPR success rate is extremely low, especially in elderly patients and where an AED cannot start a normal rhythm within a few minutes of onset. Think well under 10%. Once the heart actually stops, the chances of revival are practically zero. (An AED can only restore an abnormal rhythm, it is not intended to "restart" a heart that has stopped beating.

Over 30% of patients that receive CPR in the hospital have brain damage. For out of hospital recipients it is higher. Also, the procedure is extremely violent. Older patients almost always suffer fractured bones and other trauma. Sadly, entertainment dramatizations have led to a highly misinformed public. They have a 75% or so "success rate" and polls of the public show they believe CPR is successful more than 70% of the time, despite the true very low rates noted above.

All that being said, in younger patients, CPR combined with and AED have much higher success and fewer side effects.

 

[davidvel]

I know that CPR is very, very, very strenuous exercise. They made us perform it on a dummy for 10 minutes to get a Rescue Diver card. My arms were on fire and my back felt like an overwound clock.

That is incredible. First responders don't do it that long, mainly because there is no good reason to, but also because it is so hard to if doing CPR correctly.

 

[moonstone]

I think everybody should learn CPR and basic First Aid. When I went to college to get a diploma to allow me to work in a nursing home I had to take an advanced CPR course and a refresher course each year. I have performed CPR (with help) three times, twice at work with other employees switching out doing the pumping, and once with DH when a friend of our DD's was drunk on a snowmobile and hit a parked car at high speed around the corner from our house. It is very strenuous and my instructor told us if you don't crack a rib you aren't doing it well! I did crack or break ribs on a 92 year old frail woman that I probably wouldn't have done such vigorous pumps on, but her daughter screaming at us to save her mom (for what we dont know, she also had cancer of the bowels). She didnt make it, then the daughter was going to sue us for breaking her mom's ribs! Now that there are AED machines all over (at least here in Canada) they take the guess work out as they can tell you if CPR is necessary, do a shock to get the heart back in rhythm or if there is no hope for the heart.

A full DNR is no CPR or any other heroic life saving measures. There is an official Govt form (with unique serial number) that must be signed by a medical professional as well as the patient, or family member if the patient can not sign for themselves. A copy is sent to the Ministry of Health upon their death, if the patient lives in a retirement or nursing home a copy is in their file and if the patient still lives in their own home a copy should be readily available in case 911 is called. I had my dad's in a clear plastic sleeve taped on the door of his fridge when he was still in his own house. My mother-in-law had filed theirs in their filing cabinet and when dad collapsed and the ambulance came, they started CPR even though mum told them that dad had signed a DNR years before. The paramedics wouldn't stop life saving measures (shocking him, shots of heart meds...) until mum found the form. Now hers is in a plastic sleeve taped to the fridge.

It is a very hard decision to make for somebody else such as a parent, let alone yourself. My dad said he just couldn't sign the form for my mom when her dementia got so bad she had to go into long term care. As the co-POA I signed for Dad since, as heartless as it sounds, what is the point of prolonging the life of somebody in that state? We had family members of residents in the nursing home that just couldn't bring themselves to sign the form but knew there wasn't much point in prolonging their life. We did what was called a 'slow code' for those people. If they were showing signs of a heart attack we would go to their chart to double check their status, call (but not a stat call) a registered staff to their room and then take our times getting the resident in position -usually the floor since you cant do CPR properly on a mattress or other squishy surface. We wouldn't do CPR as vigorously as you would on a 50 year old male, but we did it.


~Diane

 

[clifffaith]

if the patient still lives in their own home a copy should be readily available in case 911 is called. I had my dad's in a clear plastic sleeve taped on the door of his fridge when he was still in his own house. My mother-in-law had filed theirs in their filing cabinet and when dad collapsed and the ambulance came, they started CPR even though mum told them that dad had signed a DNR years before. The paramedics wouldn't stop life saving measures (shocking him, shots of heart meds...) until mum found the form. Now hers is in a plastic sleeve taped to the fridge.




~Diane

Mom kept saying “you know where our trust documents, power of attorney, medical forms are in the desk drawer “. Yeah, I do, but I was completely clueless that she did not want CPR, and would never have dug that notebook out of the drawer until she was at the hospital and I had to prove to someone she didn’t want to be on a ventilator. I’m sure she stuck that form on the fridge as soon as I hung up.

 

[Sandi Bo]

And the hospital still asks - are you sure that is what you want, even if you have a DNR. At least that is what I found with my father. He could have changed his mind when admitted. But still very good point to know ahead of time, being asked those questions when being admitted is hard to process through.

My daughter, as a hospitalist, saw all sorts of these forms. They vary by state (seems a little insane to me). But as a doctor she would need to interpret whatever form someone might have. Yes, any states form is honored, just some are better than others (as best it can be, subject to interpretation). Some are fuzzy, she liked the Massachusetts one. (My mother lived in Massachusetts).

My daughter was very impressed with the Massachusetts one -- they call it MOLST (Medical Order Life Sustaining Treatment). It specifically goes through different areas of life support - not only DNR, but also ventilation, hospitalization, feeding tubes, dialysis, hydration, etc.

Admittedly, I haven't done mine - but was thinking even though I live in Nebraska, I might complete the Massachusetts one. (I have health care proxy documentation, but haven't completed an advanced directive - yes, shame on me).

My stepmother is in an assisted living facility, her DNR paperwork is kept in a nurses office (since she moved into the assisted living area). When she was in the independent area, they all have plastic tubes in the butter compartment of their refrigerators with the DNR paperwork and other medical information. That was SUPER convenient when they called 911 last year. It took me 2 seconds to hand the proper paperwork to the EMT's.

Other things that stick in my mind from talking with my daughter:
-- it's hard on the hospital staff, too. Yup it's their job, But almost a certainty, you will break bones doing CPR on an elderly person (it sucks breaking people's bones)
-- recovery rates are poor, after affects can be awful (as noted above) (as someone noted above, it's not like on TV)
-- often parents want to be let go and the children don't let them, be sure your children/medical proxies know what you want, hope they will honor that and have a physician that supports that

My stepmother was in the hospital, on oxygen as high as they could give her without intubating (a few years ago). I am her medical proxy. Talking with my daughter, saying I wasn't sure what to do -- she reminded me that my stepmother was conscious and able to make her own decisions - it was not my decision in this scenario.

My best friend was DNI (do not intubate). She was dropped off at ER with COVID -- they talked her into intubating - she was on a ventilator for a month. She is alive today. So very tough decisions and who knows given a situation what the right choice is. She had an ER physician that thought she could survive, talked her into it, and he was right!

A few years ago, my daughter walked my mother through filling out the MOLST. It was super helpful to have someone explain each thing. Right or wrong, she really hoped my mother would not want CPR. At first my mother thought she did but after talking through things, she decided she did not. There were some things she said yes to (like a CPAP, for example). It was an interesting conversation to witness. My mother did not like talking about these things. But once she understand, and made her 1st hard choice, it became easier for her to decide, and I was comfortable that her completed form expressed her decisions/wishes.

Once my mother completed it, I sent copies to all my siblings - mostly saying this is what Mom filled out. I said if you aren't comfortable with any of her answers, they could talk to her about it. This is not something anyone wants to talk about, but a better conversation to have with her or amongst us at that time, versus at the time it is possibly needed.

This is a link to where the MOLST form/info is located. There is also info on designating a heath care proxy.

https://eforms.com/advance-directiv...t that,at least two (2) witnesses to be legal.

Here's a link where you can find all states:

https://www.aarp.org/caregiving/financial-legal/free-printable-advance-directives/

Thanks for posting @clifffaith and for everyone's comments. A good reminder to stay on top of these things (something I've gotten behind on).

 

[TheHolleys87]

My dad, 98, has finally consented to move to assisted living (hooray!). Louisiana has a very detailed form that he had to review with his doc and both had to sign. My dad was able to make it very clear and official that he doesn’t want anything done - no CPR, no tube feeding, no IV fluids - to prolong his life. That’s what he’s been telling us for several years, and I’ve been trying to convince him that having his advance directive in his briefcase wouldn’t do a bit of good if something happened when none of us was around. I’m glad Louisiana made it possible for him to make his wishes known in a better way.

Edited to add - in another life I was a medical professional and knew a lot about CPR. I’m very happy that I don’t have to worry about anyone at the assisted living facility performing it on my dad.

 

[chellej]

When my dad passed away in 2012 it was very peaceful...sat down in his wheelchair and I could tell something was off by how hard he sat down. I checked him and his heart had stopped. I called 911 and they started with the directions for CPR...lay on the floor, start compressions....etc. I told the operator and the paramedics when they came he did not want recessitated. I did not have the DNR but they honored his wishes. He was 94 at the time and really had been waiting for years to join my mom.

 

[dioxide45]

I have a question because I honestly am not sure of the answer. If someone has a DNR why call 911 to have emergency services come? Shouldn't one call their doctor to come and pronounce the loved one deceased?

 

[jp10558]

I have a question because I honestly am not sure of the answer. If someone has a DNR why call 911 to have emergency services come? Shouldn't one call their doctor to come and pronounce the loved one deceased?

IDK, depends on the state. We found one of my uncles dead in his bedroom from a heart attack. The process was still to call 911, get paramedics to verify, they called the cops, who called the coroner ...

I just had a different uncle in the hospital and we thought if asked he was DNR due to age and infirmity. He was coherent enough though to tell the HCP that he wanted everything so we didn't go with what we would have thought. The doctors kept saying we should let him go, he wouldn't heal from his wounds etc. But he kept saying he wanted treatment so we kept saying do what he wants. 3 surgeries later and wound care etc and it seems like they're now planning on discharging him to a nursing home with the wound healed. IDK - he still seems like he could die at any point, but he's also been getting better so... Hard to know what to do.

 

[easyrider]

It kind of depends on the situation whether CPR will keep a person alive but in most situations where CPR is a consideration doing nothing results in death. That's why we do it, imo.

A drowning victim can often be resuscitated using CPR. A percentage of older persons can be resuscitated using CPR even if there are other medical problems so imo, I would do it. Trauma is about the only condition I would consider not doing CPR. If you try to die around me your probably getting a fist bump to the chest, chest pumps and a kiss of life, lol.

Bill

 

[Tia]

It's important to talk to your family to discuss details so everyone is prepared and understands.

 

[Brett]

I knew CPR when I was a volunteer fire & rescue squad member . ½ century ago

Fortunately my wife is a non-practicing RN and will take over medical emergencies

 

[Glynda]

It kind of depends on the situation whether CPR will keep a person alive but in most situations where CPR is a consideration doing nothing results in death. That's why we do it, imo.

A drowning victim can often be resuscitated using CPR. A percentage of older persons can be resuscitated using CPR even if there are other medical problems so imo, I would do it. Trauma is about the only condition I would consider not doing CPR. If you try to die around me your probably getting a fist bump to the chest, chest pumps and a kiss of life, lol.

Bill

Told it will break a lot of ribs.

 

[easyrider]

Told it will break a lot of ribs.

Yes, ribs will usually fracture regarding older persons but that heals up in about 12 weeks. A bigger problem is CPR can cause brain damage from a lack of oxygen to the brain because chest pumps only provide 10-20% of the blood circulation of a beating heart. Even with the odds of CPR having a bad result, the result with no CPR is death. If a person survives the CPR and hospital procedures, which might include separating the sternum for by-pass surgery, they might be in a lot of pain, they might be mentally impaired or they might be ok but they would be alive.

Bill

 

[TheHolleys87]

It's important to talk to your family to discuss details so everyone is prepared and understands.

This is the most important thing. My dad has been telling us for years - in emails and verbally, as well as making sure he had an up to date advance directive, etc. - that he absolutely did not want his life prolonged, so his three kids all knew that if something happened when we weren't around and he ended up on a ventilator in the hospital, there would be no dissent among us as far as what to tell the docs when they asked whether to continue. My dad told us of several friends whose families insisted on having "everything possible" done, which he regarded as torturing his friend.

Again, I'm so glad that the assisted living facility required completion of the Louisiana POST form, which none of us were aware of. I've attached it in case anyone is interested. Maybe your state has something similar.

 

[Glynda]

Yes, ribs will usually fracture regarding older persons but that heals up in about 12 weeks. A bigger problem is CPR can cause brain damage from a lack of oxygen to the brain because chest pumps only provide 10-20% of the blood circulation of a beating heart. Even with the odds of CPR having a bad result, the result with no CPR is death. If a person survives the CPR and hospital procedures, which might include separating the sternum for by-pass surgery, they might be in a lot of pain, they might be mentally impaired or they might be ok but they would be alive.

Bill

Having a 102 year old mother who has been living with us for 12 years I have learned that I don't want to be alive that long. Quality of life matters. She still has her mind but it's a mind that wants and thinks that she can still to do things that her body just can't. It has worn out. Her sight, her hearing, her joints might as well be gone. She shakes and the slightest touch to her skin causes her to cry out in pain. Without being able to read, to listen, to use her hands, to do the things she loved doing, to get up and down by herself and walk she just sits and sleeps. When entering this rehab she said that she was afraid. I asked what she was afraid of and she answered "Living."

 

[easyrider]

Having a 102 year old mother who has been living with us for 12 years I have learned that I don't want to be alive that long. Quality of life matters. She still has her mind but it's a mind that wants and thinks that she can still to do things that her body just can't. It has worn out. Her sight, her hearing, her joints might as well be gone. She shakes and the slightest touch to her skin causes her to cry out in pain. Without being able to read, to listen, to use her hands, to do the things she loved doing, to get up and down by herself and walk she just sits and sleeps. When entering this rehab she said that she was afraid. I asked what she was afraid of and she answered "Living."

I totally get it Glynda. I hadn't considered how old is too old or how frail is too frail so I'm sorry about that.

Bill

 

[JudyH]

I worked in hospitals my whole career. Watched at least 5 people (visitors and staff) collapse and not respond to immediate CPR.
Saw someone on an island collapse and not respond.
Had a friend recently have a kidney transplant, coded in the ICU, receive CPR and respond although with a broken rib or two.
No easy answers.

 

[clifffaith]

Saw on the news yesterday that a young-ish (40??) FedEx driver is alive after homeowner and neighbor gave him CPR on the front lawn until paramedics arrived.

 

[stmartinfan]

Interesting discussion. Like many topics, this one depends on the circumstances, I believe. Despite being in my 70s, I'm in good health and should something happen that might require CPR, I'd want it done. But 10 years from now, if my mind is failing (like my much older sibling who has had some strokes), my vote would be no. I don’t have a medical directive, so probably need to get that done and then plan to review it every few years.

My friend had an amazing experience with CPR. She woke in the middle of the night when her husband (in his 50s in good health) made an odd noise, only to discover he had stopped breathing. She immediately called 911 and operator told her to drag him to the floor and start CPR. He stayed on the phone with her and gave her explicit directions on what to do. She had learned CPR at some point in her life but of course in the moment needed someone to tell her what to do. With the operators help, she was able to continue the CPR until the medics arrived and her kids could let them in. The husband survived, required some rehab, and is now back at work with no lingering symptoms. It was one of those miracle stories that I continue to marvel over.