Ethical Conundrum: Can CPR harm?

You arrive on the scene of a cardiac arrest to find a 94-year old stage 4 cancer patient

with known metastases to the brain. No POLST or advanced directive is available. Family wants you to "do everything". As you kneel to perform high-quality compressions and break every frail bone in the patient's thorax, you know with every fiber of your being that what you're doing is wrong. You are not providing the best care for the patient.

This is the dilemma we find ourselves in daily. How do we best care for such patients? We are taught in EMT and medic school how to kick ass, be aggressive, and get "saves". We expect this career will be filled with campfire and breakroom stories about how we saved lives. Reality is, they all die sometime.

Our EMS culture has evolved and now we base success on return of spontaneous circulation (ROSC). But could ROSC be the wrong thing for some? ROSC simply means you got a pulse back. It does not mean "neurologically intact" brain function.

Maybe one of the reasons we have such rampant depression and suicide in EMS is because we've completely misrepresented a job well done by basing success on "the save". Saves are a poor measure of doing your job right. In such cases, we are set up for failure, you know, because humans are mortal. The simple fact is, death comes for us all. The best we can do is provide the RIGHT CARE - FOR THE RIGHT PATIENT - AT THE RIGHT TIME.

Stop measuring your success by saves. Think about each patient scenario critically. What is the best thing for the patient and family in front of you? Maybe it's aggressive chest compressions. Or, maybe it's holding a spouses hand while you talk them through their loved one's end of life. Use your EMS skills to keep the patient comfortable. Use your human skills be compassionate.

In this podcast with Dr. Dierks, we explore these difficult situations, address public misperceptions about CPR, and come to a realization that sometimes the best treatment is no treatment.

Based on an article from the New Yorker entitled "The Hidden Harms of CPR", which can be found at https://www.newyorker.com/news/the-weekend-essay/the-hidden-harms-of-cpr