CPR – Not for everyone

Dr Mark Taubert has been in the news recently and for all the right reasons it would seem. As a Palliative Care Consultant at Velindre NHS Trust, Cardiff he wrote an open letter to David Bowie about death and how there can be a ‘good’ death.

He has also discussed CPR for the elderly and whether this is always the best approach; emphasising that CPR is not always as we see it on television.

CPR can be traumatic and painful, and it is often not successful, particularly where the patient is in receipt of palliative care. Palliative care inevitably involves those who are terminally ill and with a limited life expectancy. There may also be considerable issues surrounding their capacity. Dr Taubert says the number of people who survive CPR when aged over 80 is around 3%.

The modern (British) world often struggles with death and the process of dying. We no longer observe the prolonged periods of mourning endured by our Victorian ancestors, with their memento mori and gothic cemeteries such as Arnos Vale and Highgate. Better living standards and modern medicine mean we are all living longer, but we are not necessarily living well longer. With increased age comes increased frailty and there is a generation of people living many decades longer than their parents. Although someone is more likely to survive a stroke in their 60s, they may have to bear a slow decline and ultimately death in perhaps their 90s or even 100s.

Injuries once considered fatal can now be managed so that lives are saved, but the survivor may have a short life expectancy or they may have to cope with impairment or reduced quality of life.

Palliative care seeks to ease pain and assist the transition to death. CPR may be a part of that, but being aware of both the risks and benefits may help the patient and their family when making important decisions about end of life care.