Deciding About Resuscitation 

Resuscitation refers to the methods used to try to restart the heart and lungs if they stop working. If you have a serious illness, your healthcare provider will likely talk to you and your loved ones about resuscitation and other treatments you may need in the future. Here's what you need to know when deciding about this treatment.

Your healthcare provider can tell you more about resuscitation and answer any questions you may have.

What is involved in resuscitation?

Resuscitation can involve:

• CPR (cardiopulmonary resuscitation). This is used to try to attempt to keep oxygen flowing to your body and to restart your heart if it stops beating. It involves pressing down on your chest and breathing into your mouth.

• Intubation. This is used if you can’t breathe to maintain adequate oxygen levels. A tube is placed through your mouth or nose, down your throat, and into your windpipe. The tube may be attached to a breathing machine. The machine helps pump air through the tube and into your lungs.

• Electric shocks (cardioversion or defibrillation). This is used to send brief shocks to your heart through small pads on your chest. It may help restore your heart rhythm to normal.

• Medicines. These may be used to help restart your heart.

What is the likely outcome of resuscitation?

Resuscitation can save lives. But its success rate is low. Factors such as age, health, and underlying illness can affect the outcome. How quickly resuscitation is started can also affect the outcome. Even if a person is revived, complications can happen during resuscitation that may cause further health problems or disability. It's best to discuss your goals for resuscitation with your healthcare provider to understand more about the risks and benefits of such actions. 

How do I decide if I want resuscitation?

Your provider can tell you more about resuscitation and what it means for you. If you want, you may also include family and friends in these discussions. As you make your decision, here are some things to think about or ask your provider:

• Will my illness improve? Or will it get worse? How likely is a cure?

• What are the risks and benefits of resuscitation?

• Am I likely to survive or recover fully from resuscitation?

• How might the outcome affect my health? How might it affect my comfort and quality of life?

Consider your own values or faith. Also ask for advice from those who share your values.

How do I state my decision about resuscitation?

Your healthcare providers will do resuscitation when needed unless you have a do not resuscitate (DNR) order. This order tells healthcare providers not to do resuscitation if your heart and lungs stop working. Laws about DNR orders vary from state to state. Ask your healthcare provider about what forms are needed to make sure your wishes will be followed. Here are some common features of DNR orders:              

• A DNR order must be written and signed by a healthcare provider. This can only be done with your consent. If you can’t speak for yourself, your healthcare proxy (also called a medical or healthcare power of attorney, surrogate decision-maker, or agent) may give the consent. This is a person named by you to make treatment decisions on your behalf when you can’t. A legal form called a healthcare proxy form or durable power of attorney for health care is needed to appoint this person. If you don’t have a healthcare proxy, the healthcare provider may ask a family member or close friend to decide on a DNR.

• A DNR order can be reversed. Any changes must be discussed with your healthcare provider. Make it a practice to review your decision for a DNR order each time there is a change in your health or goals of care. Also be sure to tell your healthcare proxy and loved ones of any changes in your decision.

• A DNR order does not affect whether you will receive other treatments. A DNR order does not mean do not treat. You will still receive all other treatments for pain and other symptoms as needed up until the extent that an extreme situation happens. 

Deciding about resuscitation for a loved one

Ideally, the decision about resuscitation is made with the patient’s consent. But in some cases, the decision may fall to the patient’s healthcare proxy or other adult. If you need to decide about resuscitation for a loved one, start by talking to their healthcare provider. Discuss the goals of care and the benefits and burdens of the treatment on your loved one’s health. Think about your loved one’s wishes and values. Also get advice from other healthcare team members such as a social worker or spiritual advisor, if needed.