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Resuscitation: What Does It Really Mean?

Author : Maricruz Ferrari LCSW


Working in hospital settings exposes you to so many harsh realities about the human experience. You often find yourself witnessing the most profound acts of love and kindness as well as the most devastating and heart-wrenching situations. Raw humanity unveils right in front your eyes, often vulnerable, fearful and hopeful. As you can imagine, an inescapable topic in a hospital is death and dying. It is heartbreaking to realize how unprepared we are for it and how ignorant we are about the truth of the end of life care and resuscitation.


Many people arrive at a hospital with a preconceived notion of what resuscitation means. It is often that we meet people that believe resuscitation is what they've seen in the movies and TV shows. Let me tell you something; it doesn't come close to reality. As a society, we have done an extremely poor job to create awareness and provide accurate information about what being a resuscitation code looks like. Oh, Hollywood! We fall in love with your movies and your effortless CPR to save heroes and heroines that otherwise would've left us a long time ago. Oh, filmmakers, you leave our hearts full of joy, love and happiness when you rescue heroes from purgatory. Yet, you fail miserably to tell the truth about the methods that would've been used in real life.


It is not uncommon to arrive at a hospital and have a medical professional ask you, "If you (or your loved one) have no pulse and no breathing, do you want us to let you go or do you want us to try to help you?". What kind of question is that? If you put it that way, of course, you want "help" for you or your loved one. However, is not as simple as that. "Help" in this situation actually means resuscitation intervention and not like the kind in which Jesus Christ miraculously rose from the dead. It is more the invasive, aggressive and artificial kind of way.


So what does resuscitation mean? Resuscitation is the medical intervention offered when the heart stops, and there is no breathing, basically when the body has died. If you've ever visited a hospital, you might have heard the famous "code blue" on the intercom. Sadly, it means someone has left us, but the medical team is jumping in to try to bring the patient back. Being a resuscitation code in a hospital is commonly known as being a full code. This option mainly offers attempting cardiopulmonary resuscitation (CPR) and mechanical ventilation. So let's talk about what resuscitation entails. I'm sure a medical professional can give you a more detailed clinical explanation, but this time around we'll keep it simple. Resuscitation has 4 main components:
chest compression: someone will administer compressions to the chest hard and fast. The purpose of these is to try to massage the heart to help it restart. What you rarely hear is that compressions are aggressive and invasive; they can fracture bones and ribs as well as puncture organs such as the lungs or the liver.
Defibrillation: this means administering a controlled electric shock to the heart with the purpose of re-establishing the heart rhythm. Although pretty uncommon, some patients can sustain skin burns.
Medication: it is usually administered by IV if there is one available. If not, medical staff will rapidly explore other options to insert a line that doesn't interfere with chest compressions. Many of these are cardiac medications and are administered to help re-establish the heart rhythm.
Intubation: a tube is inserted through the mouth and down the throat and the airways. The tube will be connected to a ventilator which will blow air to the patient's lungs. Once the ventilator is in place, the patient is officially on life support. At this point, the clock starts ticking in the daily reassessment for potential meaningful recovery. Multiple risks are associated with intubation. I believe one of the most significant is the risk of inability to be weaned from the ventilator.


As you can see, it is not as simple as it sounds. Resuscitation includes pretty aggressive and invasive interventions which outcome can vary from person to person. While resuscitation is a treatment available to everyone it doesn't mean it's appropriate for all. You rarely hear that the average survival rate for adults who suffer in-hospital arrest is 17% to 20%. While we all want to believe that if we ever needed resuscitation, we would come out victorious, it is essential to be realistic and understand that might not be the case. Assessing our own physical needs and health status can be helpful to determine if it's appropriate for us. Resuscitation is more suitable for younger people with better health status. Advanced age and conditions such as cancer, cirrhosis, AIDS and renal failure to name a few are associated with a poor outcome.


Several years ago I responded to a call in one of the units I cover at the hospital. Imaging was done on a dementia patient in his 80s and it revealed spine and rib fractures. The first instinct from the nurses was to think that this frail man had been falling at home or the family was not taking appropriate care of him. Some even considered potential abuse. After completing a full and thorough assessment, I found out there was a brief application of chest compressions by the paramedics before arriving at the hospital. This short, but effortful attempt caused multiple fractures to the patient's brittle bones. An intervention that is supposed to save lives caused more harm than good on a patient that was already struggling with other complications. Sadly, this family learned the hard way. What would've happened if the patient would've had a full-blown resuscitation code? The family left the hospital determined to modify the patient's health directive to prevent suffering in the future.


Not too long ago a male in his 50s arrived at the hospital with multi-system organ failure. He arrested upon arrival and resuscitation was administered. As a result, the patient was on life support in the intensive care unit. Multiple of his organs were shutting down, and he was rapidly approaching the end of life. Regardless of all the medical efforts, there was no chance of recovery. Despite all the education provided to the family, they insisted on resuscitation if the pt arrested again. We all knew it was a matter of time before the patient would try to leave us again and he didn't disappoint. Unfortunately, that man died a painful death. We tried even when we knew we would fail because that was the health directive. Like I said before, even though it is a treatment available to everyone, it is not appropriate for all.


So what's the alternative if you don't want resuscitation; what to do if you want nature to take its course when your time comes. You can choose to be a DNR - DO NOT RESUSCITATE - which means you are telling your healthcare provider that if you die naturally, you want to be left alone and die peacefully. This is also known as being a no code or AND - ALLOW NATURAL DEATH.


There you have it. I invite you to take this information as food for thought. We know resuscitation saves lives every day and has a special place in the medical world. However, consider your preferences and those of your loved ones and voice them. Consider your situation and that of your loved ones when making this kind of decision. If you struggle with health issues and even if you don't, speak openly to your healthcare provider about it and ask how such intervention could affect you and your quality of life. This could make a significant difference between a peaceful or painful exit from this world.


Author's Resource Box

Maricruz Ferrari is a Licensed Clinical Social Worker who has worked in healthcare for multiple years. During the most recent stage in her career, she has provided supportive services to people on the end of life journey. Along the way she has learned there is a significant unawareness in the community about end of life choices. It is often people go through intensively difficult medical experiences due to lack of knowledge. Maricruz wants to create more awareness over end of life issues and choices with the purpose of helping people be more prepared for the last chapter in their physical. maricruz.ferrarilcsw@gmail.com

Article Source:
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Tags:   resuscitation, end of life, CPR, death, dying end of life, death, social work, hospice, Clinical Social Worker, healthcare, life choices, medical choice, end of life care, end of life care options, end of life care hospice, end of life planning, end of life planning, end of life decisions, living will

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Submitted : 2019-02-06    Word Count : 1304    Times Viewed: 53