The dark side of CPR - Cardiac arrest in elderly patients
CPR is well known to be the best medical intervention to save lives. Easy to learn, provided by everyone and essential to save people during cardiac arrest. However, there are some cases in which CPR might not be the right solution, in order to avoid complications.
What if the patient in cardiac arrest is a 90-year old person?
Imagine for a moment the fragile body of a woman in her 90s, who has a multiplicity of chronic diseases, including dementia, after it has been subject to vigorous and unsuccessful CPR. Rib bones will have been crunched, soft tissue bruised and teeth broken. And that is the indiscriminate use of CPR among the frail elderly simply because there is no DNACPR (Do Not Attempt Cardiopulmonary Resuscitation order) in place.
About this topic, Dr. John Launer, on the Postgraduate Medical Journal explains:
“Doctors who are called at the time of death will typically feel they have no authority to withhold CPR, or they fear the legal risks of doing so – in spite of knowing that what they are doing is pointless. Their fear is understandable. In the UK, the guidance from the Resuscitation Council states there should be an initial presumption in favour of CPR and regulators continue to impose sanctions on clinicians who decided not to resuscitate patients who had been dead for some time.”
There is clearly a need for an alteration in mindset about the nature of resuscitation and of death itself. Launer suggests a good starting point is to recognise that hospitals nowadays are mostly full of people with multiple comorbidities who at some point are going to die from these illnesses. When they do so, their hearts will stop.