Resuscitation decisions

Abstract

Cardiopulmonary resuscitation (CPR) is an intervention developed in the field of emergency medicine to restore circulatory and respiratory functioning in a person who has experienced cardiac or respiratory arrest. CPR incorporates a spectrum of procedures ranging from basic life support measures such as mouth-to-mouth ventilation and "closed chest" compression administered by a "rescuer" to advanced cardiac life support techniques, including electrical defibrillation, open-chest cardiac massage, or the use of pharmaceuticals administered by a team of health care professionals in a hospital setting. When it was originally introduced, CPR was designed to resuscitate victims of drowning, electrocution, drug overdose and other accidents as well as acute myocardial infarction (heart attack). During the 1960s and 1970s the use of CPR expanded beyond the field of emergency medicine, and became the standard of care for virtually all dying patients.1 More recently, however, questions have arisen about the appropriateness of CPR for patients who are "rescued from death" only to prolong the process of dying, or who survive the immediate threat of cardiopulmonary failure but suffer from neuro-cognitive problems ranging from mild intellectual impairments to a permanent vegetative state.