Should I receive CPR and mechanical ventilation?

Introduction

This information will help you understand your choices if you are facing a life-limiting illness and are trying to decide whether to receive CPR and mechanical ventilation.

Key points in making your decision

When you have been diagnosed with a potentially life-limiting illness, you should talk with your doctor about your illness, your treatment options, and the likelihood that aggressive medical care, such as cardiopulmonary resuscitation (CPR) and life support, will increase your survival. Your doctor may also discuss the possibility that the quality of your life may be compromised, if CPR and life support are not successful at returning you to your normal activities.

If you have a life-limiting illness and you want to decide about receiving CPR and mechanical ventilation, your decision will involve several factors, including:

• Your medical problems and overall health. Studies have shown that people with more than one medical problem are less likely to benefit from CPR.¹ If you have a medical condition in addition to your life-limiting illness, you may feel that CPR may only prolong the dying process. On the other hand, if you feel that every possible step should be taken to preserve life, you may opt for CPR.
• Your life goals. Your potentially life-limiting illness may force you to adjust your goals for your future. If your life has been rewarding and you have accomplished many goals, you may not believe that life support is desirable. On the other hand, you may be willing to pursue life support if you feel that you may be able to prolong your life and resume your activities. If you have relationships that need work, you may feel that life support may offer an opportunity to work on strengthening relationships and give you time to say good-bye.
• Your beliefs about life support. You may choose aggressive medical care if you believe that it offers hope that you may be able to resume your normal activities. But you may feel that aggressive medical care may only prolong your life artificially and will not allow you to die naturally.

Your doctor will help you understand the risks and benefits of aggressive medical care. Talk to your doctor and family about CPR and mechanical ventilation, then put your wishes and plans in writing through an advance directive. An advance directive is a legal document that helps ensure your health care wishes will be respected if you become unable to communicate for yourself. For more information, see the topic Writing an Advance Directive.

Medical Information

What are CPR and mechanical ventilation?

CPR

If you choose to receive cardiopulmonary resuscitation (CPR) when your breathing or heart stops, a trained person, such as a paramedic, will fill your lungs with air by breathing into your mouth. If you are in the hospital when your breathing or heart stops, a team of doctors, nurses, and other trained health professionals will respond (called a 'code').

If health professionals cannot detect a pulse, a rescuer will compress your heart by applying pressure to your chest. Chest compressions are done to help circulate blood through your body. The health professionals may use a device called a defibrillator to apply an electrical shock to your heart. The electrical shock may help your heart pump on its own again. Medicines may also be injected into a vein to help your heart beat again.

Mechanical ventilation

After CPR has been started, you may be connected to a machine called a ventilator or respirator if you cannot breathe on your own. A tube (called an endotracheal tube, or ET tube) will be placed into your mouth and down your windpipe (trachea). The ET tube will then be connected to the ventilator, which pumps oxygen into your lungs. Being placed on a ventilator is sometimes referred to as 'being put on life support.'

Who might benefit from CPR and mechanical ventilation?

When you have been diagnosed with a life-limiting (terminal) illness, it is your decision whether to receive CPR and life support. Studies have shown that CPR does not usually benefit people with chronic, debilitating illnesses, including people who:¹

• Have more than one chronic medical problem. For example, a person with severe emphysema and heart failure is less likely to benefit from CPR than a person with mild emphysema and no other health problems.
• Do not live independently, but rely on others to provide their care (for example, people who live in a nursing home).
• Have been diagnosed with a life-limiting illness, such as certain types of cancer.
• Have been diagnosed with dementia.

Although aggressive medical treatment may not benefit elderly people with chronic, life-limiting illnesses, it may be appropriate for some people. If you are generally healthy, CPR and mechanical ventilation may offer you the chance to return to your normal activities and may be an acceptable personal decision. In any case, it is important to thoroughly discuss treatment options and the possible outcomes for each option with your doctor and family.

What are the benefits of CPR and mechanical ventilation?

Some people may benefit from CPR, mechanical ventilation, or both. If you are relatively healthy, CPR and mechanical ventilation may be helpful. If you need CPR because of an emergency condition that is not related to your life-threatening illness, you may want to consider CPR. However, the cause is not always obvious when a person's breathing or heart stops.

Talk to your doctor about your medical condition and the possible benefits of CPR and life support.

What are the risks of CPR and mechanical ventilation?

People in a frail condition who receive CPR, mechanical ventilation, or both generally do not have results as good as people who are healthy.¹ Ribs can be broken from the chest compressions in CPR. A lack of oxygen to the brain, which can occur when the heart stops, may lead to brain damage. Although CPR may revive you and mechanical ventilation may sustain your life, you may not be able to return to the life you had prior to receiving life support.

CPR and mechanical ventilation may reduce your chance of a calm, peaceful death. Although your life may be prolonged, your remaining time may be spent in a hospital connected to a life-support machine. Some people fear a loss of dignity at the prospect of being in such a state.

If you have not communicated your wishes about CPR and mechanical ventilation and your breathing or heart stops, your doctor and family may face difficult decisions. In an emergency situation, CPR probably will be started. After CPR is started, you may be placed on a ventilator if you are unable to breathe on your own, even if you do not want to be placed on a ventilator. If you have not communicated your wishes, your doctor and family may have a difficult time deciding how aggressively to continue your medical care. Also, it may be very difficult for your family to determine when to remove the ventilator.

What are the risks of not receiving CPR and mechanical ventilation?

CPR and mechanical ventilation focus on prolonging life. If you choose not to receive CPR or mechanical ventilation and your breathing or heart stops, your breathing and heart may not start again and you may die. Even though you have been diagnosed with a life-limiting illness, your death may happen unexpectedly, which can be traumatic for family members who may need an opportunity to say good-bye.

If you are facing a life-limiting illness and choose not to receive CPR and mechanical ventilation, communicate this clearly to your doctor and family. Many states require a doctor's order to release paramedics and other health professionals from the obligation to start resuscitation. Ask your doctor about a "Do Not Resuscitate" order. Be specific about your wishes. Use this time to share your feelings about not wanting to prolong your life. This time can be an opportunity to share memories, nurture your relationships with others, and say good-bye. If your death happens quickly and unexpectedly, your family may feel assured that you received the medical care you wanted and you died in the manner you wished.

If you need more information, see the topic Care at the End of Life.

Your Information

This information will be helpful if you are facing a life-limiting illness and are trying to decide whether to choose CPR and mechanical ventilation.

When you are diagnosed with a serious illness, your doctor will discuss treatment options with you, as well as how likely it is that your illness can be cured. If your illness cannot be cured and your life will most likely be shortened by the illness, your doctor may talk to you about receiving care that will help you remain comfortable without prolonging your life. Your doctor may also talk to you about your desire to be revived (resuscitated) when your illness progresses and your breathing stops. Ask your doctor to be as specific as possible when discussing your treatment options.

In general, your choices are:

• Choose to receive CPR and mechanical ventilation if your breathing or heart stops.
• Choose not to receive CPR and mechanical ventilation if your breathing or heart stops.
• Choose to receive mechanical ventilation but not CPR if your illness gets worse. For instance, you may choose to receive ventilator support if a chronic illness such as chronic obstructive pulmonary disease (COPD) gets worse.

The decision about whether to receive CPR and mechanical ventilation takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about receiving CPR and mechanical ventilation. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to receive or not receive CPR and mechanical ventilation.

Check the box below that represents your overall impression about your decision.

Return to the topic:

• Care at the End of Life
• Heart Attack and Unstable Angina
• Writing an Advance Directive

References

Citations

1. Dunn H (2001). Cardiopulmonary resuscitation. In Hard Choices for Loving People, 4th ed., pp. 11-16. Herndon, VA: A and A Publishers.