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Common Questions & Answers
About Cardiopulmonary
Resuscitation (CPR)
What you should know about CPR
There often comes a time when patients are so ill
that they may only be kept alive by “artificial” means.
Prior to about 1960, such patients died, but since
then a number of life-sustaining or even life-restoring
technologies have been invented, providing patients,
families and physicians with previously unimaginable
options. These technologies may at times be clearly
beneficial and assist in restoring the patient to
health. At other times the very same technology
serves only to prolong dying and even increase the
suffering of the patient. In such cases, physicians will
often recommend that the technology be withheld
and that the focus of treatment shift from cure to
comfort. The purpose of this publication is to provide
you with information about one of these life-restoring
technologies, cardiopulmonary resuscitation (CPR).
What is CPR?
CPR is a medical intervention performed on a
person whose heart has stopped beating (cardiac
arrest) or whose breathing has stopped (respiratory
arrest). CPR generally includes forceful compression
of the chest over the breastbone, the placement of
a tube in the windpipe (intubation) with artificial
(mechanical) assisted breathing, electrical shocks
to the body, the placement of large-needle IV
(intravenous) lines for the administration of drugs
and other more complicated procedures.
Does CPR work?
Yes and no. It is most effective in younger adult
patients with certain types of heart problems or in
response to complications from various medical
interventions. In fact, CPR was invented to respond
to unexpected death associated with anesthesia or
surgery. Subsequently, many citizens in our society
have been trained to perform basic CPR while
awaiting the arrival of medical professionals. Heart
defibrillators are often available in public spaces and
many persons know of someone whose life was
saved by CPR. However, CPR is significantly less
successful than portrayed on television. Overall it does
not work as often or as well as many think. This is
especially true when CPR is performed in the setting
of expected death, and it often increases suffering.
What are the circumstances of patients for whom
CPR increases suffering and is not likely to work?
Frail and often older patients with multiple acute
and chronic medical problems such as advanced
cancer, infections, heart, liver, lung or kidney
diseases so severe that they must be hospitalized
are unlikely to benefit from CPR. These are patients
for whom physicians may be providing aggressive
medical therapies, and yet the physician would not
be surprised if the patient died. Although CPR may
initially restore a heartbeat in up to 25 percent of
such patients, very few of these patients survive long
enough to be discharged from the hospital. When
they do survive, they typically have serious brain
injuries and need other forms of life support that
require nursing home care. See end notes.
Given the poor results in such
patients, what do doctors
recommend?
When CPR is likely to fail, physicians will usually
follow one of the oldest ethical principles of medicine,
first do no harm, and recommend that resuscitation
not be attempted in the event of death. A Do Not
Attempt Resuscitation (DNAR) order will be written,
meaning that chest compressions, intubation,
electrical shocks and the other technological
interventions of CPR will not be attempted.
How does a DNAR order affect
other decisions about life-sustaining
treatments?
DNAR orders alone do not mean other treatments
will be withdrawn or withheld. At Baylor Scott &
