Cardiopulmonary resuscitation may be a staple of hospital dramas and the movies, but it is not nearly as successful at saving lives as onscreen depictions indicate.
The survival rate after CPR is only about 13-20 per cent in hospital, and is lower if the cardiac arrest happens out of hospital, according to the Irish Hospice Foundation. When a patient is in the final stages of an incurable illness and death is expected within a few days, the success rate of CPR is even lower – less than 5 per cent, according to some studies.
For patients with cancer that has spread to other parts of the body, just 1.9 per cent of patients survive CPR and leave hospital, according to one study.
The average survival rate for patients over the age of 80 in the same study was about 3 per cent.
When a person suffers a cardiac arrest and does not receive prompt CPR their chance of survival decreases by 10 per cent for every minute that nothing is done, the Irish Heart Foundation said.
Broken bones
But for older patients, CPR can result in broken bones, and barely improved prospects. One study found that when older hospitalised patients needed revival by CPR, more than half were likely to die before they were discharged.
CPR is sometimes wrongly equated with resuscitation, which can involve putting someone on a drip or giving them a blood transfusion.
A decision not to attempt CPR (known as a DNAR – do not attempt resuscitation) only applies to resuscitation and does not apply to any other treatment, eg, IV antibiotics, oxygen therapy or dialysis.
About 5,000 people a year died in Ireland from cardiac arrest, most of them in their own homes. Calling an ambulance and using a defibrillator are usually the best options, but in some cases performing CPR, by pressing hard and fast on the centre of a person’s chest and breathing into their mouth, may offer the best chance of survival.
Individual assessment
Decisions about CPR should be made on the basis of an individual assessment taking account of the likelihood of success, the balance of benefits and risks and the person’s preferences.
Patients should always have care plans dealing with CPR and other issues. These should spell out their preferences for the future, including their wishes in relation to the treatments available.
Where a patient lacks capacity and their wishes are not known, decisions about CPR should be based on a clinical judgment about its benefits and risks the person and their condition.
