The line between life and death: cardiac arrest and CPR.
In the most recent episode of Pomegranate Health, The Royal Australasian College of Physicians (RACP) talks to four experts in the field about the language around cardiac arrest and how this can contribute to low quality care in hospital.
RACP Fellows, Cardiologist Dr Tammy Pegg, Palliative Care Physician, Dr Kate Grundy, and along with Intensivist Dr Alex Psirides, and retired UK-based Palliative Care Physician Dr Kathryn Mannix, talk about the overuse of CPR in deteriorating, hospitalised patient.
This is an episode not to be missed.
For those who love the world’s game, football (or soccer), there may be a hazy recollection of Danish player, Christian Eriksen’s, 2021 on-field dramatic emergency that stunned not only players, officials and fans in the stadium, but also the world. A healthy, 29-year professional sports person falls to the ground during a match.
Like the scene from a movie, Eriksen, Danish Football Player of the Year, runs out onto the pitch of Copenhagen’s International Football Stadium. Only minutes from half-time, Eriksen crashes to the ground. Within minutes, the Team Doctor and paramedics are administering chest compressions, before a defibrillator finally brings him back. At a press conference after the match, the doctor will say, “He was gone… but we got him back after one defib.”
But not all patients are as lucky as Eriksen to be young and healthy and have a team of doctors and paramedics on standby, and even if they are, is “cardiopulmonary resuscitation”, the appropriate course of action. While many acknowledge that in instances where patients are not in a hospital setting, administering CPR generally has a positive impact for the patient, however, when patients are in hospital with a defibrillator just a minute away, CPR is not a useful bridging therapy, and can, in fact, cause considerable harm.
Dr Alex Psirides, Intensive Care specialist at Wellington Regional Hospital, spoke to some interesting findings in research he co-authored with Dr Pegg.
So, if CPR is not the only option, what else is there? Should physicians and other medical professionals be discussing options with patients long before a critical incident. Are better conversations with patients a critical point in all patient care?
“I don't think any algorithm is going to take the place of having honest, open conversations with patients who, humans are not machines, and they're not very predictable as far as how things are going to go,” said Dr Kate Grundy.
“Doctors and nurses are part our people within society, and we have our own fears and our biases, and we also are often just as fearful of dying and of facing dying as our patients are. So, we tend to fall back onto the comfortable territory of treatment options that we have available, and CPR is one of those treatment options,” she added.
Or, as Dr Kathryn Mannix adds, “This is an upstream conversation as part of the progressive illness dialogue with the cardiologist, respiratory physician, who knows this person, and possibly also their general practitioner.”
As well as this confusion about the benefits of CPR in admitted patients, surveys of Australasian medical practitioners show that the majority consider CPR to include defibrillation and drugs not just chest compressions and ventilation. As a result, Do Not Attempt CPR orders get perceived as being “a stop sign” to other treatments that may be beneficial.
This podcast follows a compelling and critical conversation for all medical professionals that is not to be missed. Many thanks to Dr Tammy Pegg, Dr Kate Grundy, Dr Alex Psirides, and Dr Kathryn Mannix for being so generous with their thoughts, expertise and time.
This podcast was an exploratory conversation and not intended to represent any formal views of the Royal Australasian College of Physicians.
You can visit our website to listen to the full podcast on the RACP website, or search for ‘Pomegranate Health’ on Spotify, Apple Podcasts, Castbox or any podcasting app. Remember to subscribe to access the latest episodes first.
Pomegranate Health, an initiative of The Royal Australasian College of Physicians (RACP), is a podcast about the culture of medicine and is presented by Mic Cavazzini.
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