CPR:
wrong
default

September 10, 2022 -- In today's Medscape Should We Always Offer CPR? Dr. Mallidi of our very own San Francisco General Hospital (I loved working there) writes movingly of CPR given ineffectually to a dying patient. Since no DNR nor Advance Directive directed otherwise, medical staff was obliged to implement the default: all available measures. To no avail, or worse. But why beat him up on his inevitable way out?

Dr. Mallidi suggests we change the default. She cites a proposal by physicians from Columbia University Medical Center, Harvard Medical School, Massachusetts General Hospital, and Boston Children's Hospital. They proposed changes to how we decide whether to attempt resuscitation. Instead of CPR by default:

  1. Consider CPR when the benefits vs. risks are uncertain, and the patient is not end-stage;

  2. Recommend against CPR when there is a low likelihood of benefit and high likelihood of harm (e.g. patients with anoxic brain injury, advanced incurable cancer, or end-stage multiorgan dysfunction); and

  3. Do not offer CPR to patients who will die imminently and have no chance of surviving CPR (e.g. patients with multiorgan dysfunction, increasing pressor requirements, and those who are actively dying without a single immediately reversible cause).

And -- everybody! -- write that Advance Directive!

Go Dr. Mallidi! Go enlightened caregivers!

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