You may think you know about CPR (cardiopulmonary resuscitation) based on what you've seen on television. But is that accurate? How effective is CPR, really? And how does it fit into an overall end-of-life plan?

CPR [transcript]

[00:00:00] CPR. We may think that we know what we mean by CPR, but learning more about it contained a bunch of surprises for me. So I wanna pass this along to you. 

[00:00:11] CPR stands for cardiopulmonary resuscitation. That's the process of doing chest compressions in order to manipulate the heart, in order to keep the blood moving. CPR usually also includes rescue breathing. Forcing the air into the lungs manually by the person who is doing CPR. CPR in a hospital in particular, often includes intubation, which is the process of putting a tube down the throat into the lungs to feed oxygen into the body. The whole reason for doing CPR is to keep oxygen flowing to the brain in order to postpone or avoid having some brain damage.

[00:00:51] CPR happens when the heart is stopped and the person is not breathing. By definition, if your heart has stopped and you're not breathing, you have already died. We often talk about CPR as if it's saving somebody's life or keeping them alive — and that's certainly how it's talked about on television, in the movies, and in sort of general popular culture — but we have to change the way that we think about CPR. It's an attempt to bring somebody back who has already died. Their heart has already stopped. They've already stopped breathing, and so they are already dead. It's not rescue, it's resuscitation. 

[00:01:31] And the reason that that's important is because the person who's doing CPR actually has not a great chance of success, percentage-wise. Statistically (here's the big surprise) on television the survival rate from CPR is like 70 or 80%. It's a great plot point. It creates a lot of drama. It's really used in a lot of shows and people often recover and they have no side effects. The person starts talking, you know, once they've been revived, it's all fine.

[00:02:02] But in real life, the survival rate of CPR in a hospital is like 15% and it's much lower outside of the hospital. And of that 15%, a small percentage is still alive a year later. So the person has actually a very small chance of coming back with CPR in the best of conditions, which is in a hospital. And also often the person has some significant side effects.

[00:02:31] What kind of side effects can come from CPR? Well, it can cause complications like a broken rib or multiple broken ribs or broken sternum. It can also weaken the lungs requiring the use of a ventilator eventually from that intubation. Also, the longer it takes to bring somebody back, the more risk there is of brain damage or the more extensive the brain damage that happens as a result of not having oxygen going to the brain.

[00:02:58] Why I'm talking about this and why it's really important for you to know — especially when you're filling out your advanced directive — is because if someone is close to the end of their life or they're frail already, especially if their bones are frail, then it's really important to consider the impact of these kinds of injuries and these side effects on the quality of their life.

[00:03:18] Recovering from broken bones, having a tube down your throat, having all of this general, like heavy, heavy intervention in a already weakened body can be quite traumatic. And so carefully consider whether or not you want to have CPR. 

[00:03:36] In my own advanced directives, I actually have specified that if you need to revive me more than twice in 24 hours, then stop doing CPR. That way I account for the fact that right now I'm still pretty healthy and my bones can probably recover. And so if it's just general CPR on the way that I am right now, then yeah, please go ahead and do it. I'm, I'm very likely to be able to recover from the kinds of side effects that are experienced during CPR. However, if the reason that they have to administer CPR is because I've had some kind of like terrible accident and my body is generally just shutting down and the recovery from it is going to be really extensive and difficult, my body's probably gonna try to die a couple of times within 24 hours or shut down immediately after I'm revived. So I don't want that. There's a point at which it's just too hard on me, my loved ones, and the medical staff, honestly, to try to continue to revive someone whose body is clearly just trying to let go. So for my own advanced directives, I've put in a clause that says that I do want CPR, but not more than twice in 24 hours.