when to complete a DNR?

My husband was looking at his advance medical directive, and there was a separate page if he wanted to fill out a DNR, and he would have to get it signed by his doctor. He is 71 and has an aortic aneurysm that is being monitored. I realized if he filled out a dnr, I probably am not supposed to do cpr if I suddenly find him unresponsive and call 911. But he is only 71. This led us to discuss this and I wondered is there an age you have picked where you do not want to be resucitated? We talked it over and kind of concluded early 70's is too young to say no cpr, for us. Maybe we'll do it at 80? What have the rest of you done?

I don’t age should be the factor. What would life be for the person or their loved ones after the expected incident is my criteria. I’m there too. Decided It is too soon to give up.

There is a certain age past when CPR has a high chance of a poor outcome even if the person lives. Something to look up and fact check me on, but it's my understanding. I've talked about it with my doctor but the details are uncertain. It probably has a lot to do ith the person's health to start out with.

I have done CPR on a fair number of elderly folks, and they have generally had positive outcomes.

CPR in the field from a witnessed cardiac event is a different animal than in-hospital CPR.

Here, with our trained and involved civilian population, we have a ~100% positive outcome rate for witnessed, shockable-rhythm out-of-hospital cardiac arrests. The highest rate in the nation - national average is 32%. For all events, we are running ~28%, national average is 8%.

For in-hospital CPR, expect a 15-25% positive outcome rate.

That is "CPR" isn't one thing, it's context-dependent.

https://www.resuscitationacademy.org/

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Originally Posted by bae

I have done CPR on a fair number of elderly folks, and they have generally had positive outcomes.

CPR in the field from a witnessed cardiac event is a different animal than in-hospital CPR.

Here, with our trained and involved civilian population, we have a ~100% positive outcome rate for witnessed, shockable-rhythm out-of-hospital cardiac arrests. The highest rate in the nation - national average is 32%. For all events, we are running ~28%, national average is 8%.

For in-hospital CPR, expect a 15-25% positive outcome rate.

That is "CPR" isn't one thing, it's context-dependent.

https://www.resuscitationacademy.org/

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Thank you for the resource. If he had an event where the aneurysm ruptured, would pushing on his chest be the right thing to do?

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Originally Posted by Tybee

Thank you for the resource. If he had an event where the aneurysm ruptured, would pushing on his chest be the right thing to do?

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CPR is basically replacing the pumping action of a heart that for whatever reason isn't functioning correctly, until you can restore the heart to functionality. If the "plumbing" of the body won't hold pressure (say due to trauma), all CPR will do is pump out the remaining blood from the patient quicker. So, ideally you like to fix the plumbing ASAP (direct pressure on wounds, chest seals, etc.)

In the case of an aortic aneurysm, I'd say it all depends on the size of the "plumbing failure". Depending on the size (or if it is simply another sort of cardiac issue), CPR will provide some chance of reaching definitive surgical care, or it may do nothing at all. CPR *will* be pumping blood out of the circulatory system through the "plumbing failure".

Good recovery from cardiac events revolves around keeping blood flowing to the brain - every minute without brain perfusion in a (recoverable) cardiac event reduces positive outcomes by roughly 10%, so it's essential to start CPR ASAP and get someone to call 911 and grab an AED.

In your husband's case, I'd have him ask the doctor what the story is, in detail.

Further thing to think about - I myself think it is terribly cruel to perform CPR on frail elderly people who have lots of other issues going on and who are unlikely to recover well - proper CPR tends to break bones on such folks, and the recovery time is long.

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Originally Posted by bae

Further thing to think about - I myself think it is terribly cruel to perform CPR on frail elderly people who have lots of other issues going on and who are unlikely to recover well - proper CPR tends to break bones on such folks, and the recovery time is long.

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Yes, this.

Thank you, this helps, we should talk to the doctor. The plumbing defect analogy is very helpful. And you would not necessarily know that was what it was, either; he has other rhythm defects. But otherwise he is a very healthy guy and it would seem terrible to not do CPR. I can see age is not the determinant, but on the other hand, it's certainly a factor--there was no way we would have let them do CPR on my parents in their nineties, for example.

When we were talking about it it became apparent that he thought that DNR meant do not put him on life support, which I don't think is correct? Neither of us wants to be on a ventilator. I think this was part of our confusion.