On television shows, cardiopulmonary resuscitation (CPR) almost always works. In reality, the success rate is shockingly low. A study of 1177 patients in Rochester, NY who had cardiac arrests in a hospital showed that not more than 20% survived, and only 5% of the patients were alive one year later. If you receive CPR for a heart attack outside of a hospital, the survival rate is only 5-10%. The survival rate of elderly persons with chronic illness receiving CPR is less than 5%.
In the past, CPR was used on patients having a heart attack, but Vicki Kind, clinical bioethicist, says now it is used on everyone. It can be more complex than the chest compressions and mouth-to-mouth taught in CPR classes. If you need CPR now, it might be medicine to help restart your heart and intubation (i.e., putting a tube down your throat). In addition, you could be put on a breathing machine (ventilator), in addition to chest compression and mouth-to-mouth.
With a tube down your throat and/or ventilator, you will be unable to speak. There are ways you can communicate your wishes about CPR and other emergency life-saving techniques to medical personnel if you are unable to speak.
When I was guardian of my grandmother, who had advanced dementia and was frail, I had a doctor sign a do not resuscitate (DNR) order. If she received CPR, her ribs could have been broken and CPR could have created additional short-term and long-term negative consequences.
An Advance Medical Directive is a form used to indicate who you want to make medical decisions if you can’t make them and what types of treatment you would want to receive if you were terminal, in a coma, or in an end-stage condition (e.g., Parkinson’s). At McMillan Metro, we encourage our clients to have an Advance Medical Directive as part of their estate plan, and it is signed and witnessed in our law offices. However, for our clients who are frail or have a chronic illness, we go one step further.
Maryland, the District of Columbia, and Virginia each have a document that converts patients’ decisions on their Advance Medical Directive into a medical order because the document is signed by your physician and it must be followed by emergency medical technicians (EMTs) and the hospital. In Maryland, this form is called the Maryland Medical Order for Life-Sustaining Treatment (MOLST); in the District of Columbia, it is called a comfort care order-do not resuscitate (CCO-DNR) program; and, in Virginia, it is called a Durable Do Not Resuscitate (DDNR) for CPR. In some Virginia counties, the POST (Physician Orders for Scope of Treatment) form is used for CPR and other life-sustaining procedures.
Once the form is signed, it is important to post it on your refrigerator or near the front door of your home because that is where an EMT will look for it. If you are in the hospital and the MOLST form is completed, it is supposed to follow you. Thus, if you are moved to a rehabilitation facility, the form should also go to the facility too.
Be sure that your form is placed in your medical record at your doctor’s office. Sometimes the forms get lost, so it is helpful if your loved ones know that you have completed it. As of January 1, 2016, doctors are reimbursed by Medicare to have conversations about advance care planning with their patients. If your doctor does not broach this subject, we encourage you to bring it up with him or her.
If you feel strongly about not receiving CPR or other life-sustaining procedures, it is crucial that the appropriate life-sustaining form be completed now. Please call me at (240) 778-2310 to discuss your advance medical directive documents and the form for life-sustaining treatment.