A NUMBER of people have been contacted by medical professionals in recent weeks about do-not-resuscitate orders. Contrary to some media reports this is not because doctors are rationing care or trying to abandon vulnerable people due to the virus.

The truth is that coronavirus has not changed our approach to CPR or resuscitation in the UK at all, it has just publicised it more.

A lot of misconceptions exist around CPR. The TV portrayal that someone has a heart attack, gets CPR and then jumps up and makes a cup of tea couldn’t be further from the truth. CPR is started when a person has a cardiac arrest (ie the heart stops) and for your heart to stop you already must be critically unwell. Even if the heart restarts you would still be in that same critically unwell state after the CPR.

CPR works by creating pressure in the chest caused by someone pressing hard and fast against your rib cage. This pressure then squeezes blood out of the heart and round the body to keep the brain alive until the heart can be shocked back to a normal rhythm.

Rescue breaths (ie mouth to mouth) also keep the blood filled with oxygen needed for the brain to survive. Another common misconception is that you shouldn’t do rescue breaths anymore. The guidance changed to say that if you don’t want to do rescue breaths then just do compressions, however the message got confused. Breaths and compressions are always better than compressions alone if you are willing and able to do both.

CPR is not risk free. If the CPR is being done with the necessary speed and force this will usually crack ribs or injure the muscular and connective tissues of the chest. The brain will usually already have had a period without oxygen and already be partially damaged along with other organs.

And now we get to the really important message. Only 10% of people survive cardiac arrests and they are usually people who were already fit and young. Of that 10% many survive with devastating brain injuries and sometimes in vegetative states.

So if a doctor suggests a do not resuscitate order it is not because care is being rationed, it is because CPR is likely to be futile and will only add injury and indignity at the end of someone’s life.