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Resuscitation Planning

(continued from Resuscitation Planning)

 

How successful is resuscitation through CPR?

When successful, CPR restores heartbeat and breathing and may allow someone to resume their previous lifestyle. The success of CPR depends on a person’s overall medical condition. Age alone does not determine whether CPR will be successful, although age-related illnesses and frailties can be a factor.

CPR is more successful in saving the lives of those who do not have serious underlying illnesses. It is most successful when a person suffers a cardiac arrest or respiratory arrest in hospital, such as in a cardiac or intensive care unit and is attended to immediately.

Various studies have found that initial in-hospital CPR success rates range from 16.8 to 44%. Long-term survival (discharge from hospital) rates range from 3.1 to 16.5%. An indication of overall CPR success rates if the arrest occurs in hospital appears in the table below:

Diagnosis 1, 2 Success Rate for CPR
Respiratory failure 18.9%
Heart condition 16.2%
Head injury 7.2%
Acute renal failure 2.7%
Survival after 24 hours 9.2%
Survival to hospital discharge 8.3%
 

Will CPR be right for me?

This decision may only be reached after you (or if you lack capacity, your substitute decision-maker(s)) discuss it in some detail with your doctor. You may have very strong views about whether resuscitation is something you want, given the risks that will be explained to you by your doctor.

When a person suffers an arrest, it will always be considered an emergency situation. However, the decision of whether CPR should be provided does not need to be made in an emergency, particularly if it is an expected arrest. Where there is any clinical doubt and no one is aware of your wishes, the decision will always be in favour of providing CPR to attempt to save your life.

What is tube feeding?

Sometimes resuscitation planning might involve talking about tube feeding. The techincal term for tube feeding is "artifical hydration and nutrition" (see Glossary). Tube feeding is not a basic treatment that can be administered by anyone, as say food and water by mouth. Tube feeding involves technical medical therapy by experts trained in this area. Unlike providing food or other forms of comfort (such as pain management), the procedures required for tube feeding often have uncertain benefits and considerable risks and discomfort. These factors need to be considered carefully before tube feeding is started.

Beliefs about food and the associations concerning food are deep- seated, and in some communities they are linked to historical or personal experiences with starvation. However, it is often reported that those entering the dying or terminal phase of their illness may lose their appetite and show no interest in food. In high-quality palliative care, symptoms of hunger or thirst can often be managed effectively without the provision of artificial hydration or nutrition.

In fact, many studies demonstrate that while tube feeding may prolong life in some circumstances it can also pose a high risk to some patients. The goal of any tube feeding should be to increase the level of a person’s comfort. In line with all informed consent discussions, your doctor will explain any potential benefits as well as risks and discomfort that may be experienced.

If you are being cared for in the family home, it is very important that you make others aware of your wishes about calling the ambulance service.  

What happens if an ambulance is called?

As a general rule, the ambulance service does not have access to the records kept at a hospital or nursing home. If you are not in hospital and become ill or you have a cardiac or respiratory arrest, someone will probably call an ambulance if you have not expressed your wishes (for example, that you do not want to be resuscitated).

The Queensland Ambulance Service's operating standard is that the attending paramedics will perform CPR and other resuscitation procedures in an emergency unless formal paperwork is in order refusing any specific resuscitation effort. Therefore, if you have strong wishes about not being resuscitated, you should formalise your decision and complete an Advance Health Directive to that effect. The attending paramedics will need to view the paperwork so it is important that it is readily accessible.

If you do not wish to have CPR performed on you, you need to make it very clear in your Advance Health Directive, including the circumstances in which this should apply. Even if your substitute decision-maker(s) is with you when the ambulance is called and you suffer a cardiac or respiratory arrest, the attending paramedics will perform CPR on you if your legal documents are not in order or cannot be found. The reason for this is that it is Queensland Ambulance Service procedure that not providing CPR must be under the direction of a doctor.

While no-one likes to talk about an emergency situation that might require an ambulance to be called, it is necessary to do so if you want your wishes respected.

  Reference for table above:
1 Brooks, S.C. et al. (2010). Out-of-hospital cardiac arrest frequency and survival: Evidence for temporal variability. Resuscitation, 81(2) 175-181.
2 Myrianthefs, P. et al. (2003). Efficacy of CPR in a general, adult ICU. Resuscitation, 57(1) 43-48.

For more information please contact the Ethics Team, Access Improvement Service at QHclinicalethics@health.qld.gov.au or mail to GPO BOX 48, 4000, Brisbane, Australia