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As a medical trainee I feel I am in a position to give an objective
opinion on in-hospital cardiopulmonary arrest. I have attended and led on
a number of 'arrest' situations and in none has the patient survived
beyond 24 hours. Cardiopulmonary resuscitation (CPR) is a unique
intervention in that its odds of success are so slight. With any
treatment, there are subpopulations of patients who will derive more
benefit than others and CPR is no different. This fact underpins
clinicians’ decisions to withhold CPR for certain patients on the basis
that treatment would be futile and therefore not in their best interests.
I believe that resuscitation for patients entering hospital should be an
opt-in procedure. As our population ages and our capacity to harbour
multiple comorbidities increases, we collectively become poorer candidates
for CPR. Surely then it becomes even more important to identify the group
of patients who are likely to benefit from CPR. Opting in would make
clinicians consider a patient’s resuscitation status early in the
admission, and where discussion is required would turn a negative
discussion into a positive one. It would hopefully correct the widely held
lay opinion that CPR is ‘lifesaving’ and clear the confusion between ‘do
not attempt resuscitation’, ceiling of care and active treatment amongst
some healthcare providers.
Competing interests:
None declared
Competing interests:
No competing interests
23 February 2010
M Haider Ali
Core Medical Trainee
Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP
Anyone for CPR?
As a medical trainee I feel I am in a position to give an objective
opinion on in-hospital cardiopulmonary arrest. I have attended and led on
a number of 'arrest' situations and in none has the patient survived
beyond 24 hours. Cardiopulmonary resuscitation (CPR) is a unique
intervention in that its odds of success are so slight. With any
treatment, there are subpopulations of patients who will derive more
benefit than others and CPR is no different. This fact underpins
clinicians’ decisions to withhold CPR for certain patients on the basis
that treatment would be futile and therefore not in their best interests.
I believe that resuscitation for patients entering hospital should be an
opt-in procedure. As our population ages and our capacity to harbour
multiple comorbidities increases, we collectively become poorer candidates
for CPR. Surely then it becomes even more important to identify the group
of patients who are likely to benefit from CPR. Opting in would make
clinicians consider a patient’s resuscitation status early in the
admission, and where discussion is required would turn a negative
discussion into a positive one. It would hopefully correct the widely held
lay opinion that CPR is ‘lifesaving’ and clear the confusion between ‘do
not attempt resuscitation’, ceiling of care and active treatment amongst
some healthcare providers.
Competing interests:
None declared
Competing interests: No competing interests