CPR or Resuscitation

Steps to follow in case of CPR 

Risks of CPR

The main risk of resuscitation is that it is sometimes possible to get the heart going again, but that the brain has been deprived of oxygen for too long. Damage is a fact if the oxygen deprivation lasts longer than 6 minutes. About 15 to 20% of all people survive CPR. Of these, 80% are discharged from the hospital with a positive state of health. 20% Of survivors have brain damage.

Medical science is making more and more possible. That does not mean that every medical treatment is still useful and must be implemented at all times. This is especially true for end-of-life care. The goal of any medical treatment should always be to promote the well-being of the patient and not to prolong life per se.

Our healthcare providers reflect extensively on these decisions regarding whether or not to start or stop life-prolonging treatments for patients in this situation.

Will of the patient

• The patient's wishes and will come first. Sometimes the patient is still quite capable of expressing this himself. In other cases, his legal representative does this for him.
• Sometimes the patient has previously discussed his wishes with the general practitioner or doctor at the residential care center and recorded them in advanced care planning documents, or has recorded his wishes in a living will.

Doctor responsibility

• For each treatment, the doctor remains responsible and decides whether a certain medical act is still useful. In doing so, he takes into account the current state of medical science and the burden on the patient in question.
• A physician cannot be obliged to start or continue a medically futile treatment.
• In difficult decision-making processes, the treatment team shall hold extensive consultations with the patient or his representatives or close relatives.

DNR code

• The attending doctor registers decisions regarding the limitation of medical care in the electronic patient file with a DNR code.
• DNR stands for Do Not Reanimate, although this code informs about much more than just whether or not to resuscitate.
• The DNR code makes it clear to all health care providers in the hospital what is still desirable. The code ensures that everyone is aware of treatment arrangements so they can be followed 24 hours a day.
• No matter what DNR code was assigned, we strive for optimal patient comfort in all circumstances (pain management, wound care, etc.).
• The following DNR codes exist:
  • Code 0: no therapy limitation: resuscitation is performed and all life-saving treatments are still being done.
  • Code 1: no resuscitation
  • Code 2: no resuscitation + existing treatment no longer extended, but still extending comfort care
  • Code 3: no resuscitation + reduce existing treatment, but still extend comfort care where necessary

Who determines the DNR code and does the patient have input?

• The attending doctor records in the electronic patient file the DNR code for each patient he admits, even if there is no restriction (code 0).
• With the DNR code, he also records with whom the therapy restriction agreements were made (patient, based on a living will, representative, general practitoner), when and about which specific restriction.
• The doctor discusses all this as much as possible with the patient and his family. The care team provides reasoned advice about the code of treatment limitation to the patient and his family, but never, for emotional and psychological reasons, leaves the responsibility for this decision with the patient or his family. This decision is therefore a medical decision under the final responsibility of the doctor.

How long is a DNR code valid?

• A DNR code can be set during hospitalization, and in the context of changing circumstances during admission, a code can change (e.g., from DNR 1 to DNR 2 or from DNR 2 to DNR 1).
• The DNR code automatically expires upon discharge from the hospital, home, to a nursing home or other health care facility.
• The DNR decision that was pending at the end of hospitalization must be communicated to the new attending doctor. He reevaluates this DNR decision according to the medical condition in the new environment.