Clarifying Cardiopulmonary resuscitation (CPR) and Do-Not-Resuscitate (DNR) orders

News & Updates | May 17, 2024 | Dying With Dignity Canada

Home / News & Updates / Clarifying Cardiopulmonary resuscitation (CPR) and Do-Not-Resuscitate (DNR) orders
A photo of two paramedics performing CPR on a patient.

At Dying With Dignity Canada, we believe that everyone should know their rights as a patient, understand the various treatment for which they may be eligible, and record their wishes in an Advance Care Plan. We interviewed Dr. Hayden Rubensohn to help us understand specific options available to us when in the health care system. 

What is CPR – manual and by machine? 

CPR is a technique that is used to try and restart a heart after a cardiac arrest. Part of the technique includes trying to continue moving blood and oxygen around the body by compressing and decompressing the heart to mimic a heart beat. Sometimes that is done manually by people pressing on the chest, but sometimes a machine can be used to do the pressing instead of a human. 

How often is it successful? 

Not often. It depends on a lot of factors such as what caused the cardiac arrest, if it was witnessed or not, if it occurred in hospital or not. The age of the patient is the biggest factor determining success; there is less success the older someone gets. Even a healthy 70-year-old shows their age when their heart stops. Underlying medical issues also contribute to lack of success.  

Can there be health consequences after receiving CPR? 

It’s important not to just think about success as “getting the heart going again,” but also to think about survival to discharge, and physical/mental function afterwards. Any time the heart isn’t beating naturally inadequate oxygen reaches the brain, resulting in rapid brain damage. 

Are there consequences if someone tries CPR on someone and it is unsuccessful or injures them? 

CPR is rarely physically dangerous, although it can result in muscle strain. More than that, it’s important to know that it’s a fairly violent procedure and can be traumatic to witness or participate in. There is a great risk of unpleasant memories surrounding a loved one’s death if they receive CPR and it is not successful. 

What is a Do-Not-Resuscitate order? 

A Do-Not-Resuscitate order tells medical professionals not to undertake CPR in the event of a cardiac arrest, and rather to let nature take its course, allowing for a natural end of life. It can be further refined to indicate whether intubation and mechanical ventilation are acceptable or not, and whether admission to an intensive care unit is acceptable or not. A DNR order DOES NOT mean stopping all medical care. 

Why would someone put in place a DNR order? 

People choose to have a DNR in place when they decide they don’t want, or won’t benefit from highly invasive care, such as CPR, intubation/ventilation, or a transfer to an intensive care unit.  

How does someone put in place a DNR order? 

The best way is to talk to their family doctor, specialists, and family members. Usually, their doctor will help get the order in place, but it’s important for family members to know someone’s wishes as well. 

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