On every admission to the hospital I watch our hospitalists (the usual term for the doctor that admits most patient into the hospital setting) ask patients what their preference is on code status. We ask regardless of the patient’s diagnosis, and most of us in the business consider this a good step forward in honoring patient’s wishes should the worst happen. Time after time, however, I watch patient’s grapple with this question, it evokes a range of emotion, mostly initial fear.
Not choosing usually results in a status of Full Code on the chart. In not choosing, the patient has made a choice – a choice to receive heroic life saving measures in the event their heart or spontaneous breathing stops. Those who are unconscious, altered, or otherwise unable to make a choice, are similarly listed as full code unless a copy of their living will or a medical power of attorney is present.
How informed are these choices however? We are asking patients at their most vulnerable moments to make a huge decision, and more often than not, the person asking is unlikely to provide critical information necessary for decision making. (I don’t say this as a measure of blame, frankly I understand the feeling that this vulnerable moment isn’t a great time to introduce the poor statistics on CPR success rate or the possible damages done in the process of performing CPR).
I write this however, so that you reading, here and now, have the information, so you can understand the reality and protect yourself and your wishes accordingly. My hope is that you are not in your most vulnerable time right now, that your head is clear and that you can hear the facts logically enough to make the choice that is right for you, before it ever becomes that question asked at the moment of admission, or worse, the moment of needed resuscitation.
Please understand – CPR has it’s merits, or it wouldn’t be such a wide-spread tool. CPR however, carries its greatest benefit if you suffer a sudden cardiac arrest in the non-medical world and well-trained bystanders and/or EMS staff promptly start CPR efforts. In these cases CPR from a bystander offers three times the likelihood of revival as opposed to those that receive no early intervention. It’s worth a shot right? Of course.
In the hospital setting however, we are not in an episode of Grey’s Anatomy or ER. George Clooney isn’t jumping up and down on your chest in a valiant effort to bring you back. Well trained Doctors and Nurses, EMT’s and Paramedics are providing a life saving intervention that often, is beyond traumatic to the human body and statistically quite ineffective. No one wants to tell you that however, for a multitude of reasons. The statistics vary quite widely according to source, but no matter what source, the reality falls far short of the world-wide perception – which estimates the population in general believes that CPR is statistically successful. Shows like ER, Chicago Hope, Grey’s Anatomy show success rates at around 75%.
In a CNN article in 2013 – “Exact survival rates are difficult to come by, as studies generally look at specific populations. A 2012 study showed that only about 2% of adults who collapse on the street and receive CPR recover fully. Another from 2009 (PDF) showed that anywhere from 4% to 16% of patients who received bystander CPR were eventually discharged from the hospital. About 18% of seniors who receive CPR at the hospital survive to be discharged, according to a third study (PDF).” http://www.cnn.com/2013/07/10/health/cpr-lifesaving-stats/
According to Compassion And Support – an organization in the Rochester area that strives to improve end-of-life care:
Survival rate of CPR on television shows: –> 66%
Actual in-hospital survival rates for CPR:All hospital patients: ——————————-> 15%
Frail elders*: —————————————–> <5%
Individuals with advanced chronic illness**: -> <1%
No matter what source you choose, the reality is far below the expectation. Beyond that there are often complications of CPR that few rarely think of. Effective compressions, especially on the elderly with frail bones, cause rib fractures and possibly punctured lungs. Anyone with an extended time of resuscitation has a high likelihood of brain damage. Even those that are revived often have a long recovery, many never leave the hospital and those that do leave often do so in a far different state than they entered.
These statistics are scary, but they are necessary to face in making informed and appropriate decisions about your own end-of-life choices. My hope is that those who read this share the information, that they discuss these realities with people in their lives who need to understand. I find myself often these days, in idle conversation, asking those I care about what their perception is of CPR success rates. More often than not I hear much of what is reported here about general thoughts on CPR – approximately a 60-75% success rate. The reality astounds people and makes them think twice about what their lack of communication/documentation of their choices on extraordinary life saving measures leaves them possibly vulnerable to.
Make your choice, and let it be known.