Cardiopulmonary resuscitation (CPR) was first introduced in 1960. CPR combines chest compressions with artificial ventilation in an effort to preserve intact brain function until further measures can be taken to revive an individual.
As far as the physician’s oath to “do no harm,” this sounds just fine — and many patients are proponents of receiving CPR in life-threatening circumstances. However, others choose to be labeled as DNR (do not resuscitate) or NFR (not for resuscitation) — a wish not to receive CPR in the event of a cardiac arrest.
There’s long been an ethical debate on how to balance the best interests of the patient and, ultimately, how not to do more harm than good. A new study adds weight to this discussion, spotlighting the dismal survival rates for older adults who received CPR.
CPR, by default
Medical literature has continuously reported that, for adults over 80, survival rates post-CPR are grim. However, this new research published in the Journal of the American Geriatrics Society highlights that, despite poor outcomes, how often health care professionals choose to resuscitate anyway.
The researchers sampled about 600 clinicians (including doctors, nurses, paramedics and emergency technicians) and asked them to recall their most recent patient over the age of 80 who’d received CPR. The physicians were asked how they felt about their decision to perform CPR or withhold it. Were they sure of their choice or did they ultimately feel uncertain?
Though, within the sample, only 2% of the patients survived long enough to leave the hospital, more than half of the physicians still stood by the decision to administer CPR. On the other hand, 18.5% thought CPR to be inappropriate based on outcomes.
A shockable rhythm
During cardiac arrest, the minority of patients have a “shockable rhythm.” This means that their heart is still abnormally beating but it’s not pumping blood efficiently. CPR combined with defibrillation to shock the heart may restore circulation and save the individual’s life.
More often, though, patients have “non-shockable rhythms”: their hearts exhibit electrical activity but are not pumping at all. These individuals’ survival rates plummet drastically.
As we age, it’s more likely to experience a cardiac arrest with a non-shockable rhythm. And, in the current study of adults over 80, about 90% of CPR attempts included non-shockable rhythms.
None of the sampled patients with non-shockable rhythms survived hospitalization. However, numerous clinicians (44%) still believed the CPR was warranted.
Many physicians wonder when CPR should be stopped — but what about when it should be started? “A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts,” the study’s authors wrote.
More discussion is certainly needed to figure out the discrepancy between dismal survival rates in older CPR patients and physicians still deeming resuscitation appropriate.
Currently, CPR is the default for almost everyone. The question is: Should this remain the case?