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Doctors differ on whether hospices should follow CPR guidelines
March 27, 2009Head to head: Should hospices be exempt from following national cardiopulmonary resuscitation guidelines?
Experts in two papers published on bmj.com today disagree on whether cardiopulmonary resuscitation (CPR) guidelines should apply to hospices.
Dr Max Watson and colleagues believe that CPR is not always appropriate for patients who are dying and that hospices should be able to develop their own guidelines. However, Drs Claud Regnard and Fiona Randall argue that it is "inconceivable" that hospices should seek exemption from the good practice set out in the UK guidelines.
Watson says that blanket rules on CPR do not work in hospices because the needs of these patients are unique. In a hospice "the goal for the majority is quality of life and a dignified death", he argues. Dr Watson goes further and says that full CPR facilities are often not possible in hospices and that it is disingenuous to discuss this issue with patients when only basic life support equipment and training may be available.
In conclusion, Watson calls for specific hospice guidelines that are clear, simple and robust and that one national policy for both the acute and the hospice sector is too ambitious.
But Regnard and Randall believe that the current guidelines "uphold essential core principles and values that particularly apply in end of life care." They argue that the guidelines provide essential protection for patients and that it makes no sense to seek exemption from them. For example, the guidelines protect patients from arbitrary discrimination, safeguard a patient's right to receive or refuse CPR, and protect dying patients.
Regnard and Randall also argue that CPR decisions are determined by what is in the patient's best interest. Therefore if a patient lacked capacity and was unable to survive CPR then the procedure would not go ahead, "these safeguards are essential to prevent unnecessary distress for patients, partners, and relatives at the end of life," they say.
"Working to different rules in hospices would result in confusion, exclude hospice patients from recognised good practice, and would seriously compromise working partnerships with colleagues in other settings. Exemption would create poorer, and thus inequitable, care for hospice patients," they conclude.
BMJ-British Medical Journal
Watson says that blanket rules on CPR do not work in hospices because the needs of these patients are unique. In a hospice "the goal for the majority is quality of life and a dignified death", he argues. Dr Watson goes further and says that full CPR facilities are often not possible in hospices and that it is disingenuous to discuss this issue with patients when only basic life support equipment and training may be available.
In conclusion, Watson calls for specific hospice guidelines that are clear, simple and robust and that one national policy for both the acute and the hospice sector is too ambitious.
But Regnard and Randall believe that the current guidelines "uphold essential core principles and values that particularly apply in end of life care." They argue that the guidelines provide essential protection for patients and that it makes no sense to seek exemption from them. For example, the guidelines protect patients from arbitrary discrimination, safeguard a patient's right to receive or refuse CPR, and protect dying patients.
Regnard and Randall also argue that CPR decisions are determined by what is in the patient's best interest. Therefore if a patient lacked capacity and was unable to survive CPR then the procedure would not go ahead, "these safeguards are essential to prevent unnecessary distress for patients, partners, and relatives at the end of life," they say.
"Working to different rules in hospices would result in confusion, exclude hospice patients from recognised good practice, and would seriously compromise working partnerships with colleagues in other settings. Exemption would create poorer, and thus inequitable, care for hospice patients," they conclude.
BMJ-British Medical Journal
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Researchers at St. Michael's Hospital working in conjunction with EMS services, paramedics and fire services across Ontario found that a bystander who attempts cardiopulmonary resuscitation (CPR) can quadruple the survival rate to over 50 per cent.
NHLBI stops enrollment in study on resuscitation methods for cardiac arrest
Enrollment has ended early in a large, multicenter clinical trial comparing two distinct resuscitation strategies delivered by emergency medical service (EMS) providers to increase blood flow during cardiac arrest.
Cardiac arrest resuscitation: Passive oxygen flow better than assisted ventilation
Arizona researchers have added another piece to the mounting body of evidence that suggests during resuscitation efforts to treat patients in cardiac arrest, "passive ventilation" significantly increases survival rates, compared to the widely practiced "assisted ventilation."
Hospitalized patients need better understanding of CPR and outcomes
Many hospitalized patients overestimate their chance of surviving an in-hospital cardiac arrest and do not know what CPR really involves, a University of Iowa study has shown.
Sleep Apnea May Be Risk Factor for Sudden Cardiac Death, Mayo Clinic Research Concludes
After studying the sleep characteristics of nearly 11,000 adults in an overnight sleep laboratory, Mayo Clinic researchers suggest that obstructive sleep apnea (OSA) - and, in particular, the low nighttime oxygen saturation of the blood it causes - may be a risk factor for sudden cardiac death (SCD).
Mayo Clinic study finds risk of sudden cardiac death highest early after attack
People who survive a heart attack face the greatest risk of dying from sudden cardiac death (SCD) during the first month after leaving the hospital, according to a long-term community study by Mayo Clinic researchers of nearly 3,000 heart attack survivors.
Automated External Defibrillators and CPR Are Equally Helpful for Sudden Cardiac Arrest in the Home
The first study to explore the use of automated external defibrillator (AEDs) in the home has found that although the safe and easy-to-use devices are effective for certain types of cardiac arrest, they were underused.
Mock CPR
Staging mock cardiac and respiratory arrests - "code" situations in hospital parlance - easily expose common failures in rapid response with CPR and other life-saving care for children and also set up powerful incentives to sharpen emergency skills and move fast to use them, suggests a study from the Johns Hopkins Children's Center.
Recalled toy beads still available in the UK, warn doctors
Toy beads that were internationally recalled last year, after concerns that they may be coated with a dangerous chemical, are still being advertised on toy shop websites for purchase in the UK, warn doctors in this week's BMJ.
Anyone can save a life: Penn researchers lead national efforts to improve CPR quality
"Anyone can save a life." That's the message from physicians at the University of Pennsylvania School of Medicine.
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Cardiopulmonary Resuscitation (Contemporary Cardiology) by Joseph P. Ornato (Editor), Mary Ann Peberdy (Editor) An in-depth review by leading authorities of the latest therapies and techniques for rescuing persons in cardiac arrest. The authors explore the physiology behind current state-of-the-art clinical resuscitation and translate it into practical bedside recommendations, clinical tips, and expert techniques. Topics of interest include the epidemiology of sudden death, management of ventilation, chest compression technique training, public access defibrillation, drug delivery during CPR, the latest drug therapies, and cardiac arrest in disease, pregnancy, drowning, lightning strike, and trauma. The authors also review the major ongoing research in resuscitation science that will likely affect the next set of international resuscitation guidelines. |
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Family & Friends CPR Anytime Personal Learning Program by Laerdal Kit for personal use with family and friends. Latex Free. Directions printed inside the box. |
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CPR - The Way To Save Lives (Cardiopulmonary Resuscitation For The General Public) Also With: Dan Halligan (Producer) Following the basic life support standards of the American Heart Association and the American Red Cross, gives easy-to-understand instruction in adult, child and infant CPR. |
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CPR Face Shield, 1 Each by Dynarex CPR Face Shield by Dynarex: A lightweight face shield to prevent mouth to mouth contact during CPR. One way valve eliminates blowback to caregiver. Individually poly bagged. Contains detailed instruction sheet |
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Experiments In The Revival Of Organisms Film DVD: 1940 Film "Experiments In The Revival Of Organisms" About Resuscitation & The History Of The Revival Of Animals, From Russia This film documents some early Russian scientific experiments with the resuscitation of animals. Dr. S.S. Bryukhonenko at the Institute of Experimental Physiology and Therapy, Voronezh, U.S.S.R. The footage is bizarre to say the least. Table Of Contents: (1) Experiment in the Revival of Organisms (1940) - This film documents some early Russian scientific experiments with the resuscitation of animals, mostly dogs, by Dr. S.S. Bryukhonenko at the Institute of Experimental Physiology and Therapy, Voronezh, U.S.S.R. - 20 Minutes |
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2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care by American Heart Association (Corporate Author) | |
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First Response: The ABCD's of CPR (Adult Version) DVD by AIMS Multimedia First Response: The ABCDs of CPR is the most progressive and expansive program resource of its kind. |
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Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care by American Heart Association (Author) | |
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CPR Board Cardiac Boards are rigid plastic back boards used for cardiopulmonary resuscitation, commonly called a CPR Board. It is used to provide a flat and hard surface beneath a person who requires chest compressions to pump blood through his or her circulatory system. A CPR Board may be among the standard safety items that are recommended to have on site and on a med or crash cart. Facilities requiring a CPR Board may include physician and dentist offices, gyms, swimming pools, nursing homes and elderly care facilities, clinics and hospitals. Some regulatory requirements for facility locations include they shall be required to have a CPR Board available to perform Cardiac Pulmonary Resuscitation. Each facility will need to determine what their own requirements & guidelines are. |
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Microshield CPR Kit - 1 Each by American Medical Association This 6-piece, Microshield® CPR Kit includes everything you will need in a CPR emergency. Products are contained in a sturdy, reusable plastic case. Kit includes:(1) M-571: Microshield® CPR shield (2) Exam quality vinyl gloves, 1 pair (2) Antiseptic cleansing wipes (sting free) (1) 5"x8" Germicidal (kills germs) wipe, covers 7.5 sq. ft. |
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