Doctor [???] Liz O'Riordan,
I was a life guard for ten years. Had to perform CPR once. Saved a life.
Yeah... it would have been better to let this person die...
You bring into specific relief a problem that seems to prevail unfortunately in medicine today. This oncologist is generalizing from her perspective (people sick and dying from cancer) a universal plan. It is inappropriate.
As you point out CPR is important. In the young and healthy patient CPR should absolutely be administered in the proper circumstances. What this surgeon fails to understand is that CPR is administered to save brain function and end organ function during loss of pulsatile blood flow. In adults the most common cause of this is V fib so we used to call it the hunt for VF. Keep the brain alive until treatment of a shockable rhythm.
While this physician is correct most in house codes have a miserable 30 day meaningful survival rate or is not because of CPR but because these people are quit sick with baseline illness that has progressed to end of life. It becomes the discussion of what if you have an end stage disease — does life support give you a chance at cure or artificially prolong a death? I have seen a lot of patients on life support — trach, vent, PEG, dialysis who are miserable for the last days of their lives. More often than not we find that the family is insistent on this type of care despite the wishes of the patient.
A patient has autonomy and I am not allowed to substitute my judgment for theirs in terms of whether to proceed with a full scope of care or limited measures including hospice support. (Please note this is very different than a patient or family being allowed to demand a course of treatment that in my judgment is inferior or dangerous). This is exactly why the love of my life also has full executed authority to make decisions for me in the event I cannot speak for myself. The love of my life and I also have had a full discussion of what we want. This prevents a lot of issues when the time comes.
This surgeon is correct. CPR is brutal. But she misses the irony that in surgery you are stripped naked, placed on a cold hard operating rooms table while a surgeon picks up a knife and splits you open. Using her language it appears that irony is lost on this particular surgeon.
As the article mentions, if the reason the heart stopped is because the person is terminally ill and the heart finally gives out, CPR is likely futile.
If the victim is otherwise healthy and the heart stopped because of drowning or electrocution or something like that, then CPR is a good idea.
Exactly. 20% chance is better than no chance at all.
Doctor [???] Liz O'Riordan,
however, essentially, its true...
problem occurs when CPR is not discussed and settled EARLY on in an illness....
then we start CPR, do all this trauma to the patient, send them to ICU , black and blue and on a vent....
and then the horrible part for the family having to decide to have it all stopped....
one case I remember was a terminal patient, with cancer of the esophagus, who was going to go home/hospice to die, but did not have a clear "no code" order.....he had been spitting up some but when helping him get back into bed he started spitting up and then vomiting fresh blood every where...everywhere....code was called, they did all this stuff until we finally got hold of the family to make the "no code" order....
sadly this happens more than you think....
its best to get your desires in early when sick....
like most people, the perfect death would be to just slip away in your sleep....