Making end-of-life decisions
Making end-of-life decisions including CPR/Resuscitation involves physical, spiritual and emotional issues for each patient and family member. This information will assist patients and families in making these choices.
What is CPR?
CPR stands for Cardiopulmonary Resuscitation.
When performed by a bystander, it is mouth-to-mouth breathing and chest compressions (pushing down on the chest with both hands to circulate blood through the body).
When performed by ambulance personnel or in the hospital it can include:
- Using a face mask attached to a bag filled with oxygen, which is squeezed, forcing air into the lungs.
- Placing a plastic tube through the mouth or nose into the windpipe and down to the lungs so oxygen can be blown directly into the lungs. This tube will be connected to a respirator (artificial mechanical breathing machine), also called "life support."
- Chest compressions.
- Electrical shock through paddles placed directly on the chest to correct abnormal heart rhythms.
- IV (intravenous) fluids and medication to restore heart rhythm and blood pressure.
CPR: Why not?
Originally CPR was intended for cases of accidental death such as drowning, car accidents or electrical shock. It is now used in most cases whenever the heart has stopped beating without regard for long-term benefit to the patient. In one study of 117 patients receiving CPR, 102 did not survive the resuscitation attempt. Thirteen more died in the hospital within five days. Of the two remaining survivors neither was able to return home. Many other studies have shown similar results.
Impact of CPR on quality of life
- Chest compressions may cause broken ribs and punctured lungs.
- Brain damage may occur due to lack of oxygen during resuscitation.
- Patients may end up on "life support" without the hope of recovery.
- It may reduce the likelihood of a peaceful death.
- The family may be forced to make more difficult decisions about continuing or discontinuing life support.
Patients least likely to benefit from CPR
- Those with one or more medical problems
- Those with a terminal or end-stage disease
- Those with advanced dementia
Questions to guide the decision
- What does the patient want?
- If the patient is not able to speak on his or her own, what have they said in the past?
- Why would the patient choose to have CPR?
- Has someone else been designated to make health care decisions?
- Where can the patient find support in making this decision?
How to make sure decisions about CPR/Resuscitation are honored
If the decision is made NOT to have CPR/resuscitation, there are several steps to follow:
- Discuss the decision with the doctor, family, friends and anyone involved with patient care. Remind them to call the hospice 24-hour number, not 911.
- At admission to any hospital or nursing home, make the staff and doctor aware of decisions about CPR/resuscitation.
- Complete an Emergency Medical Services/Do Not Resuscitate* (EMS/DNR) form and post it in a visible location in the home. This will alert ambulance personnel to the patient's decision not to have CPR/resuscitation.
- Complete a Living Will* (Advance Directive) that clearly states the decisions that have been made about CPR/resuscitation and other possible treatments.
- Designate, through a written document, a trusted person who will honor the decisions made regarding CPR/resuscitation. This person becomes responsible only if the patient is no longer able to make or communicate decisions.
*Copies of these forms are included in the Hospice Admission folder. The Hospice social worker can answer any questions and can assist patients and families with this process.
 Applebaum, Gary E.; King, Joyce E.; Finucane, Thomas E. The Outcome of CPR Initiated in Nursing Home. Journal of American Geriatrics Society 1990; 38:197-200
 Tresch, D.; et al. CPR in Elderly patients Hospitalized in the 1990's: A Favorable Outcome. Journal of American Geriatrics Society 1994; 42:137-141.