Cardiac arrest: Difference between revisions

Despite perfect CPR, the prognosis of cardiac arrest is very poor. While around 10-30% of out-of-hospital cardiac arrests achieve ROSC, less than 10% of them survive to hospital discharge. Many of the survivors have poor neurological function. The survival rate for in-hospital cardiac arrest is a bit better, probably due to rapid initiation of ALS and that the patient's medical history is known. The prognosis is much worse for patients with chronic illnesses; <2% of patients with advanced [[COPD]], [[heart failure]], [[malignancy]], or [[cirrhosis]] survive for at least 6 months after cardiac arrest. Patients massively overestimate the success rate of CPR (due to inaccurate displays of CPR on television) and are therefore usually unaware that CPR should not be initiated in all cases. Up to half of CPR survivors wish they hadn't been resuscitated.

It is ethically and medically inappropriate to give futile medical therapy, including CPR. The worst case scenario following CPR is that ROSC is achieved but the patient has no neurological function or needs mechanical ventilation or similar for the rest of their life. In cases where the physician percieves a patient's odds of surviving cardiopulmonary resuscitation with good neurological outcomes as very low the physician can discuss a ''do-not-resuscitate'' order with the patient, also called a DNR or a "no code". In some countries, the physician can decide this for the patient (even if the patient disagrees); this is the case in Norway, for example. In other countries, like the USA, the patient (or guardian) must agree and sign a written form. I do not know the routine in Hungary. In most cases, when patients are informed of the poor prognosis of CPR, they understand and accept their DNR order, as most would much rather allow a natural death than surviving but risking significantly reduced functioning.<section end="A&IC" /><section begin="Peri-arrest" />