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Tag: cardiopulmonary resuscitation

  • No one knows if you will become a vegetable

    Anytime I admit you to the hospital, I have to ask you about code status. In other words, if your heart stops beating, do you want us to try to start it again? (The process of attempting to do so is called cardiopulmonary resuscitation, or CPR.) If you are unable to successfully breathe on your own, do you want us to put a tube down your throat so a machine can breathe for you? (This is mechanical ventilation.) If you want both, that means you are “Full Code.” If you would not want CPR but would want to be on a ventilator, then you are DNR (Do Not Resuscitate). If you don’t want either, you are DNR/DNI (Do No Resuscitate, Do Not Intubate). If you want CPR but not intubation, too bad, you can’t do that. When your heart stops beating you also stop breathing, so you have to be ok with getting both. 

    On the regular, I will ask someone this question and they will answer, “I’d like you to try to revive me, but if it looks like I’m going to be a vegetable then stop.” 

    My answer: We can’t know if you are going to be a vegetable.

    (It goes without saying: you will never be a vegetable. We are mammals. Nothing medical science can do will ever turn you into an edible plant.)

    There is the question, what do they mean by vegetable. I think they usually mean, permanently unconscious: brain dead. Well, guess what. As doctors, even with the best tests we can’t generally say that 100%. There is a surprising amount of controversy in this area. I don’t think most people realize it is so gray.

    But more importantly, we aren’t God. If you heart stops, we have no idea what is going to happen when we start chest compressions, electric shocks and IV medication pushes. We can guess what we think is going to happen, but I’m pretty bad at that. Maybe you are just going to die. Maybe you will wake up in a minute and talk to us. Maybe we are going to pound on your chest for forty minutes and then you will be unconscious and on a ventilator in the ICU and maybe you will wake up in a few days or maybe not, and maybe if you wake up you won’t be able to move the right half of your body. Saying you want to be “Full Code” means you have to be ok with all of those options, you can’t just choose the good one.

    You know what I want your answer to be? If you are a healthy person over the age of 85, I want you to be DNR/DNI. If you are an unhealthy person over the age of 65, I want you to be DNR/DNI. If you are a really unhealthy person over the age of 40, I want you to be DNR/DNI. (Exception being if you are in surgery. Most people, even if they are DNR/DNI, will transition to Full Code during surgery, because it is so successful in this situation.)

    Why? Do I hate people? Do I want to take care of fewer patients?

    Admittedly, it’s probably bias. I haven’t seen that much CPR, actually. But the CPR I’ve seen has not been pretty. It has been brutal. And it has been mostly unsuccessful. Do you want the last minutes of your life to involve someone pounding on your chest, breaking your ribs, shoving a tube down your trachea, shocking your chest?

    Doctors, advanced practitioners, nurses and other healthcare providers go into medicine because we want to help people. Oftentimes CPR feels like we’re doing the opposite.

    I, as a healthy person in my mid-thirties, want CPR. I would want my husband, my siblings and my mom to have CPR. I’m not against it. It’s just not for everyone.

    SDG

  • Side effects of CPR

    Generously, one in three people who undergo cardiopulmonary resuscitation (CPR) in the hospital will survive. (Success rates are lower outside the hospital.) Congrats, that’s what you were hoping for! CPR does have side effects, however… but you only experience the side effects if it successful aka you are still alive.

    1. Broken ribs. This is the most classic side effect. The older you are, the more likely this is going to happen, because ribs get more brittle with age. If you are a little old lady, your ribs are going to snap like toothpicks. What do broken ribs feel like? As far as I can tell, nothing good. Breathing will be painful, so the temptation is to take little tiny breaths instead of big ones and to avoid coughing at all costs. Unfortunately, doing this sets you up for pneumonia, which you are already at increased risk for being in the hospital. So we’re going to be asking you to take those big, deep, painful breaths anyway. You may need to go on opioid pain medication in order to do so, which comes with its own litany of side effects (like constipation, confusion, and dependence).
    2. Brain damage. About one third of people who survive CPR will have brain damage. This does not mean you are an unconscious “vegetable.” But maybe you are. Or maybe you just can’t live by yourself anymore because it’s too unsafe.
    3. Trachea/vocal cord damage. If CPR goes on for more than a few minutes, we are going to try to place a breathing tube. In the process, the tube may injure your throat, including the vocal cords. Swallowing may be painful for about a week. Your voice may never be the same.
    4. More time in the hospital. No one comes out of CPR healthier than when they went in. You will likely end up in the intensive care unit for close monitoring, which is going to involve more tests, blood work, and interruptions. Almost certainly your hospital stay will be prolonged. Longer stays in the hospital mean greater chances for other things to go wrong.
    5. More likely to not go home. You’ll be weaker and may need to spend time rehabilitating in a nursing home. If you are fortunate, you will rehab back to home or move into an assisted living where you have more support. If you’re less fortunate, you’ll be a permanent nursing home resident.
    6. More likely to return to the hospital. Generally, hearts don’t just stop beating out of nowhere. You probably have some serious medical conditions that are not going to go away. You may also have more health problems as side effects of CPR. (See above.) As a result, don’t be surprised if you continue to get ill enough to require repeated hospitalization. Your doctors certainly won’t be.
    7. More likely to die. A study examining CPR in older adults with medical problems like heart failure, COPD, cirrhosis and cancer found more than half of them were dead in 6 months. 

    Again, you only get these side effects if CPR is successful: the alternative is being dead. The older, sicker and more frail you become, the more likely you will experience these side effects and the more severe the side effects are likely to be. You will also be less likely to survive to experience them.

    In general, if you are under sixty, I’d say it’s worth doing. (That recommendation would change if you have metastatic cancer or other severe health problems.) Over sixty becomes more gray as people accumulate more health problems. Ultimately, the decision is up to you, but it’s important to know what your decision means.

    SDG