There should be full information about what resuscitation actually entails.

[OverUnderSidewaysDown]

There have been a lot of press stories about older people being “forced” to sign DNR forms and understandably their families are getting upset.
However I think a lot of people believe that resuscitation is like it is on TV - pads being affixed to the chest, stand back everyone, patient miraculously recovers. It isn’t. It’s a brutal process that can result in smashed ribs, and for frail elderly people it can leave them in a much worse state, either dead or with prolonged suffering.
This should be made public knowledge, no dodging around the facts.
AIBU?

I definitely think a lot of people don't realise that a DNACPR just means no cardiopulmonary resuscitation. You can still have appropriate treatment and comfort measures up to the point where the heart stops. Maybe a campaign to provide more information would be a good thing so people are not so frightened by it? My grans GP must have done a good job explaining it to her as she carried hers in her handbag whenever she went out anywhere and, as a result had a comfortable death in hospital at 98.

YANBU OP

I was thinking about the DNR that my dad had at late stages of cancer the other day in line with the hysterical chatter that is happening at the moment.

It made me remember that it took me a day to really understand what the doctors meant and why they had put a DNR on his records, and at first I was a bit like the news reports and chat at the moment "How could you!!" "He deserves to be resuscitated" etc etc. I think it is a normal reaction to hearing the words and wanting to keep someone alive, but like you say people do not have a true view of what it involves, I sure didn't, yet I am 100% that the doctors were correct in my dad's case.

I know exactly what resuscitation involves. But DNR notices should only be after a proper discussion about why this might not be the best idea. Not pressuring people into DNR which is what is happening.
There is a lot of research to show as well that families often suffer trauma if a DNR notice is placed without pre discussion of why, and the person dies.
There is a reason the practice is to have a proper discussion. There is also a suspicion that people who should not have a DNR, are being pressured into it because of a current lack of medical resources. I have no idea if this is true or not, but given the awful way this is bring done, I think those fears are inevitable.

mobile.twitter.com/andymoz78/status/1246867139367182336

This thread explains it very well. As he notes, CPR is most effective where the heart has stopped because of an abnormal rhythm.

It’s infinitely less effective when the patient is very ill - as is the case with Covid-19 patients - with multiple organs failing, not just their heart, because even if the doctors do manage to get their heart beating again, all those huge problems will still be there, and the patient will almost certainly still die.

www.nhs.uk/conditions/end-of-life-care/advance-decision-to-refuse-treatment/

Make a living will .It certainly makes you think about things.

What people need to remember is that at the point someone’s heart stops they are already clinically dead. CPR not only serves to re-start the heart but also to keep the blood flowing around the body until the hart starts beating again - if it does.

If nothing is done, then the person is already dead.

In some instances they will start chest compressions before the heart stops but if the rate is so low that it is about to. This happened to me and it was a deeply traumatic experience until I arrested. After that I remember nothing until I woke up the next morning. HAd had a temp pacemaker fitted, was intubated plus had a feeding tube inserted, but was sedated until they took out the breathing tube. My family were warned that I might have sustained brain damage but they did hope that they’d started compressions soon enough to avoid that given they started when my heart rate had dropped to five bpm.

When I woke up my first thought was that I was in bloody agony, and it took a couple of minutes to remember why. I was fortunate, I didn’t sustain any broken ribs but the bruising was severe, and the consultant later told me that punctured lungs and suchlike are not uncommon.

But had they not done cpr I would just have arrested and been gone.

I had flashbacks to my experience for weeks after, and when the crash team were called to another patient I fell apart because of the memories that provoked.

Because of where I’m at I absolutely would want CPR again, but I wouldn’t wish it on an elderly person and I wouldn’t want it if I had e.g. been left brain damaged and completely incapacitated.

I have had a close relative on the NHS end of life pathway. Things like DNR were discussed compassionately and explained well. I totally supported a DNR in that case.
But that is not what is supposed to be happening now. I think OP you are mixing up what normally happens which is fine, with what people are complaining about now which isn't.

That's terrible @cupoftea84 clearly the LCP was,nt used correctly in your Grandmother,s case ,when I worked in dementia care it was reviewed every shift ,and people were taken off it if they improved.

Surely nobody is trying to resuscitate anyone who dies from Covid19? I mean they're dying because the illness has overwhelmed the body to the point where it shuts down. That's like trying to resuscitate someone who's died from cancer isn't it? It's not like in cases where someone has drowned, or been electrocuted, or stopped breathing after a blow to the head. With a Covid patient their organs have reached the point of no return right?

fiaryliz,I was wondering the same myself.

EndothermicHands, that was an incredible post.

I think this is a really informative and helpful thread, thanks for posting it, OverUnderSidewaysDown.

It is entirely the wrong time to ask people to do this. Everyone should have this discussion as an ongoing thing (along with organ donation) during their life.

The reason it seems so heartless now is that it comes after Cummings and his well publicised comment that the deaths of a few oldies is a low price to pay. While, factually, he may have been correct, the people receiving these requests to sign a DNR feel (rightly or wrongly) that they have been selected to die so the rest of us can live.

Good thread, though.

My mother had a DNR inplace, lodged with her GP, she was 89, she died in her sleep just over a week ago, for some reason when her carers found her in the morning, they performed CPR, which was very distressing for my brother. The paramedic said she had been dead a while when found, whether the carers had panicked I don't know; but at 89 with a pretty poor quality of life already, I cannot understand the reasoning behind trying to bring her back for more of it.

Brefugee, I don't think it's the wrong time. I know that I want a DNACPR in place for myself and I can do that myself now.

Cummings isn't alone in the way he thinks, he's just publicised as saying so. I think it's a bit inflammatory to say that people being asked to sign DNR have been selected to die, they haven't - their chances of survival would be low or with a potentially unsatisfactory and painful recovery.

I don't believe that medical staff are not being informative and kind either, it would go against their very ethos.

People need to be aware of this and not just tune into highly selective procedures on tv.

Agree. Similarly about ICU more generally, this is a great article written by an oncologist - wish we'd read it before my grandfather became very ill.

www.theguardian.com/commentisfree/2020/mar/17/now-more-than-ever-we-have-to-be-honest-about-intensive-care-beds

It should be a discussion. However inept GP’s have been incorrectly interpreting the recent guidance and contacting parents of children in the shielded group about DNR’s.

This is not the point of the DNR or the reason for the shielded group to be protected from Covid19.

It is distressing enough to know that your child is at serious risk due to a health condition, without adding further distress with requests that you consider a DNR for your child (who is much more likely to benefit from CPR in the first place).

Critical care and all that entails should be discussed with loved ones who have serious health conditions or who are of an age where the risks outweigh the benefits.

But broadly placing people into categories based on incorrect interpretation of the shielded group is wrong and has caused serious distress to parents and children.

YANBU my 92 year old grandmother signed a DNR. However my cousin who never visited the hospital, somehow managed to be there when she started to pass peacefully (it was the one time we were having a break for the evening).

Cousin went nuts and made such a screaming fuss that the medical staff resuscitated Nan. Poor Nan died two days later but with broken ribs and in a lot more pain than she’d been in before. I’ve still not forgiven my cousin for being such a massive drama lama and causing our Grandmother so much pain.

Why is it such a traumatic experience? Obviously broken ribs, mental trauma, etc, but is there something else? Many people seem to be alluding to something but not making it clear, although I completely understand why.

Is a medical resus different to performing cpr on a person in the street? I thought if you found someone not breathing then you always perform cpr on them, regardless of age. My dad is at the end of his life, and has told me many times not to sign a dnr.

If its too upsetting to actually detail it here, could someone provide a link please?

There is also a suspicion that people who should not have a DNR, are being pressured into it because of a current lack of medical resources. I have no idea if this is true or not, but given the awful way this is bring done, I think those fears are inevitable

This is true, but the trouble is that there's never a "right time"; so many won't engage when they're well, and once they or a loved one are critically ill it's all a bit late

I'd suggest a mass campaign post-virus to encourage folk to really think hard about this, but can just see the posts: "they're trying to claw back some of the money the virus cost!!"

Sadly we're all going to go sooner or later and all we can hope is that the medics will do their best for us ... which isn't always the same as what our nearest and dearest might want

There is an amzazing book by the Author/Surgeon Atul Gawande about dying and preparing for this long before you need to think about these things called Being Mortel.
It is an intellegent read for anyone which l highly recommend.

On the other end of the spectrum...I know an 82 year old who was resusicated. Broken ribs, broken hip. Healed within 24 months with a lot of physio therapy, and by 84 she was travelling by herself again. Ten years later she is still living independantly, still has all her marbles, and is very active (goes for long walks with her dog etc).

If it had been up to her GP he would have had her sign a DNR when she passed 75. And that’s the problem really. Not all old people are the same but the NHS system is ageist and often tries to treat them the same.

Fedupandpoor I think the thing is that people assume that once the heart is restarted the person will return to the condition they were in before, health-wise. But it's likely that they have sustained brain damage during the period when the brain was starved of oxygen, so they may never be the person they were before. They may even be in a coma or vegetative state. So they've been kept alive, but at the expense of a significant reduction in their quality of life.

That's my understanding - happy to be corrected by someone with more medical knowledge.

I agree - broken ribs, crushed sternum, extensive and painful bruising. It's not a pleasant process and often of little effectiveness in very ill or elderly people.

@LyingWitchInTheWardrobe
I think it's a bit inflammatory to say that people being asked to sign DNR have been selected to die, they haven't

That's not what i said though. What i said was after weeks of the media being full of them saying that, and then receiving a letter saying "sign a DNR" without much context some people would think that.

And why wouldn't they think that? There has been so much bile spouted at older people who dare to go outside (my mum gets criticised for a weekly shopping trip she lives alone and has no family close is she expected to starve?) that it's no wonder they get that impression.

And yes, right now we do need people to sign DNRs. But bloody hell, people, think of the optics of this.

As it happens most of my family have signed DNRs and are organ donors. But many many people need to have a good, rational discussion about it and reach their own conclusion without pressure. And now there is much too much pressure.

Resuscitating my brother gave a whole week in which to sort out tissue typing and arrange for multiple donor recipients to assemble at hospital. They were intending to DNR due to the traumatic brain injury he'd sustained until I told them that he used to carry a donor card. On the night of the surgery, he was resuscitated a second time, which meant that his organs weren't wasted.

So sometimes, resuscitation where there is no hope can be a good thing.

Fedupandpoor If you have a heart attack on the street then CPR can keep the oxygen pumping round your body until they can fix your heart. But proper CPR whether in the street or in the hospital is quite brutal as you need to press really hard for it to work so usually leaves bruised (and often broken) ribs. And the longer you go without oxygen, the higher risk of having brain damage even if they can fix your heart and you survive. If you have a heart attack in the street and someone does CPR, there is still only something like a 10-20% chance of surviving and not everyone who makes it to hospital comes home, let alone with a decent quality of life.

For patients in hospital with something serious like coronavirus then their whole body is damaged - lungs are knackered, kidneys are failing, blood chemistry is all over the place, other organs are shutting down, so when their heart stops it is just another step. Yes, they could resuscitate and get your heart pumping again but you still have the failing lungs, kidneys, etc that are likely to kill you anyway. The CPR doesn't fix any of them.The only difference is you now also have several broken ribs and even more pain for the extra few days you manage to live.