The document discusses the appropriateness of CPR in the context of end-of-life care, particularly for elderly patients and those with non-shockable arrhythmias. It highlights public misconceptions about CPR outcomes and emphasizes that many medical professionals question the necessity of such interventions in certain cases. The author advocates for a default 'Do Not Resuscitate' (DNR) policy, stressing the importance of clear communication regarding patients' wishes and the realities of CPR efficacy.

1. BARE KNUCKLE ICU
DNR
SHOULD BE
THE DEFAULT
@psirides
Wed June 15th

2. “
First I will define what I conceive medicine
to be. In general terms, it is to do away with
the sufferings of the sick, to lessen the
violence of their diseases, and to refuse to
treat those who are overmastered by their
disease, realising that in such cases
medicine is powerless.
#Hippocrat
400 BC

3. VideofromTheWellcomeLibrary
ABriefHistoryofCPR

4. A Brief History of CPR
5 Cases
35yr old under GA
9yr old post GA
80yr old under GA
12yr old under GA
45yr old in ED
1960
And no brain.

5. Public Perception of CPR
100 in-patients aged ≥70 years were asked
“if you had a cardiac arrest, what would happen?”
‘MisconceptionsAmongElderly
Patients’,Adamsetal2006
81% believed they had ≥50% chance of leaving
hospital with no disability
23% believed the chance of no disability
was ≥90%

6. TV Shows Country
No. Episodes
Screened
No. Cardiac
Arrests
Witnessed
Outcome
Casualty,
Cardiac Arrest,
Medics
UK 64 52* 25% survival
Grey’s Anatomy,
House
US 91 46
69.6% ROSC,
71.9% survival to hospital
discharge
ER,
Chicago Hope,
Rescue 911
US 97 60
75% ROSC,
67% survival to hospital
discharge
Star Trek: TNG,
DS9 & Voyager
Outer
Space 526 96 13% ROSC,
9% long-term survival
*48% of patients <35 years old

7. ON TV, NO-ONE ARRESTS FROM
‘OLD AGE’

9. NEJM 1996

10. PRESIDENT
TRUMP

11. Doctors Die Differently

12. 100% of doctors are trained to perform a procedure
BY DEFAULT that 90% of them wouldn’t want themselves

13. OHCA=IHCA

14. How People Die
Murray et al, BMJ 2008

15. of IHCA arrhythmias are non-shockable
72%

17. Assess Rhythm
Non-Shockable
CPR For 2 Minutes
R
E
P
E
A
T

18. Ebelletal,CriticalCareMedicine2014
38,092
patients who
received CPR
whilst an
in-patient

19. 49
DEAD
DURING
CPR
34 DEAD
BEFORE
DISCHARGE
7 DEAD BY
1 YEAR
10 ‘ALIVE’

20. “Iwanttodiepeacefullyinmy
sleeplikemyfather,not
screaming&yellinglikethe
passengersonhisbus.”
StevenWright

21. NOIN-PATIENT
SHOULDEVER
RECEIVECPR

22. 2weeksinICUcan
saveyou1hourof
difficult
conversationDr.Will Cairns

24. DNR
SHOULD BE
THE DEFAULT

25. POOR COMMUNICATION CAUSES HARM
FromCrunchGamer1viaYouTube

26. @psirides
wellingtonicu.com
AlliconstakenfromTheNounProject

27. DNR should not be the
default
Sara Gray

31. 56%
DNR should not be
the default

49. Age 70?

58. Tweet if you love resus
#pitfight
@EmICUcanada