Resuscitation

CPR:
Cardiopulmonary resuscitation is a technique used to restart a person’s heart and breathing once they have stopped. In order to restart the heart, rescuers may breathe into the person’s mouth to force air into the lungs, perform chest compressions, apply an electrical shock to the chest (known as defibrillation), use an artificial ventilator, insert a breathing tube into the throat or give drugs to stimulate the heart.


Pros:
Cons:
By performing CPR, you can prevent death so long as it is used in the correct circumstances (i.e. when the person is unconscious, has no heartbeat and is not breathing).

[For example, you shouldn't use CPR on a patient who is undergoing a heart attack because the heart is still beating. When the heart attack progresses on to a cardiac arrest and the heart has completely stopped beating, CPR can be performed.]
There is a low success rate, especially for elderly people or those with complicated medical conditions (e.g. people with cancers spreading all over the body).
By performing CPR, you can stop the person from becoming severely disabled. By restarting the heart, you can stop the brain from being starved of oxygen for too long, which improves future quality of life.
CPR usually results in broken ribs or lung contusions (bruising to the inside of the lungs) due to the amount of pressure that is needed to perform the procedure.

Mouth-to-mouth resuscitation is a form of disease transmission- although this can be prevented using mouth dams to prevent direct contact.

It is difficult to perform chest compressions correctly because the chest need to be compressed by a given number of inches in order to prevent damage to internal organs.
CPR vs DNAR:
Healthcare professionals always attempt CPR unless people have a “Do Not Attempt Resuscitation” order. This order has to be placed in the medical record and kept in a safe place. If rescuers are unable to find a DNAR order, they will have to resort to carrying out CPR.
DNAR orders are usually issued to patients if CPR is unlikely to be effective in restarting the heart and breathing. CPR is also not attempted if it will cause more harm than good. For example, people suffering from an incurable illness will not want such a medical intervention taking place to prolong their suffering and prevent them from dying a natural, dignified death.
The need for an advance care plan:
Advance care plans involve patients making well-informed, future healthcare decisions by talking to healthcare providers and loved ones, documenting their choices as part of their Living Will. As part of the plan, patients need to designate somebody to make decisions on their behalf for when they are unable to speak for themselves. Such a plan allows patients to have a say in their end-of-life care, meaning their wishes can be respected- fulfilling the ethical pillar of autonomy.

Sources:
http://sacred-heart.org/advancecare/pdfs/CPR.pdf
http://www.nygh.on.ca/data/2/rec_docs/2487_Life_Support_May2016.pdf
https://www.bma.org.uk/advice/employment/ethics/ethics-a-to-z/decisions-relating-to-cpr
By Kumaran Rajaratnam.


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