‘Cardiopulmonary resuscitation (CPR) saves lives.’ That’s what we’re told, not only by TV hospital shows but also by the Dutch heart foundation (Hartstichting). Front-line health workers, however, think resuscitating sick and elderly patients can often be a bad thing. Only 15 percent of patients survive the procedure, and those that do are often left with complications. It is also often far from clear whether or not the person would want to be reanimated.

Erik van Engelen has been a paramedic for 12 years and has saved many lives - sometimes by using resuscitation. But he’s increasingly doubtful of the benefit of CPR, because of how it can deprive especially the elderly of a peaceful death.

“For example, when we have to perform CPR on an 80- or 90-year-old who has had the luck to suffer a heart attack. In those sorts of cases I often think: wouldn’t it have been great if we hadn’t got in the way and the person had been able to breathe their last here and now.”

Broken bones
Mr Van Engelen wrote a piece for a medical journal this summer entitled Allow a patient to die. He received support from doctors and other medical personnel involved in geriatric care. His work as a paramedic means Mr Van Engelen knows just how invasive CPR can be, especially for older people.

“Patients’ bones are brittle because of their age. You push on the ribcage, and can break them. Fractured ribs can cause problems in one or even both lungs. The lung membrane can be punctured. That’s how to go from bad to worse.”

Dilemma
Ambulance personnel are obliged if in doubt to perform CPR on patients when called out in an emergency, even if the patient’s chance of survival is minimal. Only a doctor has the authority to rule out resuscitation. Piet Postema has worked as a family doctor in Amsterdam for 35 years. He is only too aware of the dilemma faced by paramedics like Mr Van Engelen. About 20 to 30 of the patients of Dr Postema’s practice die in an average year.

“They’re almost all elderly. We try to ensure they have a good death. That’s very important for them and for the people around them. You’ve got to be really sure of yourself to decide against resuscitation. It can be a really difficult decision.”

That’s why he advises children and partners of elderly people to think carefully before calling an ambulance.

Only 15 percent survive
Medical sociologist, Hugo van der Wedden says research shows that CPR is widely perceived as an almost magical procedure. Most Dutch people think that it’s successful in 50 percent of cases. The truth is quite different: on average in the Netherlands, only 15 percent of people survive resuscitation.

This idea has led to an enormous taboo against not employing CPR. That influences most medical personnel, explains Mr Van der Wedden.

“It’s often the case that nursing staff are at the bedside of someone who, as far as they are concerned, has died. The person would prefer to lie peacefully and have the tubes disconnected, with respect for the dead. But society demands that they fall on the body and treat it with considerable violence, even though they don’t think this is right.”

Dignified death
Mr Van der Wedden says that’s why health workers and nurses, against their better judgement still choose to resuscitate people and deny them a dignified death.

The Verenso association for geriatricians is calling for doctors, GP practices and ambulance staff to have access to information about whether or not elderly people want CPR to be performed on them in an emergency. It says this information needs to be better exchanged between the various institutions caring for the elderly.

(mw)