Wednesday, October 11, 2006


Here is an interesting entry about CPR & DNR in response to a New York Times article, The Last Word on the Last Breath.

I was surprised that an actual analysis was done & published in the NEJM on survival rates in CPR on TV!

I remember how dismal the success rate was during my stint in A & E oh-so-many years ago. Most of the patients who were admitted collapsed had already been down for more than 15 minutes. At that time (I don't know about now), the paramedical staff in the ambulances did not do intubations on the field. So most of the time, our efforts in the department were basically "going-through-the-motions" for a reasonable amount of time, before pronouncing death. Most of these collapsed patients had pre-existing co-morbidities & elderly or were victims of severe trauma, so our efforts were not unexpectedly futile. I remember the sickening crunch of breaking ribs while I did chest compressions, especially in the elderly & frail.

The only time I managed to bring back a patient was a gentleman in his 50's suffering from an acute exacerbation of COPD, who, right in front of my eyes, desaturated & went into ventricular fibrillation. Immediate CPR was instituted, & he was successfully resuscitated & immediately sent up to the medical ICU (whose MO was not terribly happy with accepting this very ill patient, but hey, what to do, A & E in those days were not equipped or staffed to monitor patients requiring close monitoring).

Even in the wards, many family members still insisted on going all out for the patient in spite of how gravely ill that patient was. Perhaps they didn't realise how traumatic CPR can be on an already weakened body. I can certainly understand why letting go is hard.

When my time comes, I will make sure that my family understands my wishes & let me go in peace. I admit I have yet to sign an AMD nor have I made a living will. It's one of those things which one keeps putting off, thinking that one still has time to do it. I really should get off my a** & get it done...

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