What are CPR and mechanical ventilation?
If you choose to receive cardiopulmonary
resuscitation (CPR) when your breathing or heart stops, a trained person, such
as a paramedic, will fill your lungs with air by breathing into your mouth. If
you are in the hospital when your breathing or heart stops, a team of doctors,
nurses, and other trained health professionals will respond (called a
If health professionals cannot detect a pulse, a rescuer
will compress your heart by applying pressure to your chest. Chest compressions
are done to help circulate blood through your body. The health professionals
may use a device called a defibrillator to apply an electrical shock to your
heart. The electrical shock may help your heart pump on its own again.
Medicines may also be injected into a vein to help your heart beat
After CPR has been started, you may be connected to a machine called a
ventilator or respirator if you cannot breathe on your own. A tube (called an
endotracheal tube, or ET tube) will be placed into your mouth and down your
windpipe (trachea). The ET tube will then be connected to the ventilator, which
pumps oxygen into your lungs. Being placed on a ventilator is sometimes
referred to as "being put on life support."
Who might benefit from CPR and mechanical ventilation?
When you have been diagnosed with a life-limiting (terminal) illness, it
is your decision whether to receive CPR and life support. Studies have shown
that CPR does not usually benefit people with chronic, debilitating illnesses,
including people who:1
- Have more than one chronic medical problem.
For example, a person with severe
heart failure is less likely to benefit from CPR than
a person with mild emphysema and no other health problems.
- Do not
live independently, but rely on others to provide their care (for example,
people who live in a nursing home).
- Have been diagnosed with a
life-limiting illness, such as certain types of cancer.
- Have been
Although aggressive medical treatment may not benefit
elderly people with chronic, life-limiting illnesses, it may be appropriate for
some people. If you are generally healthy, CPR and mechanical ventilation may
offer you the chance to return to your normal activities and may be an
acceptable personal decision. In any case, it is important to thoroughly
discuss treatment options and the possible outcomes for each option with your
doctor and family.
What are the benefits of CPR and mechanical ventilation?
Some people may benefit from CPR, mechanical ventilation, or both. If you
are relatively healthy, CPR and mechanical ventilation may be helpful. If you
need CPR because of an emergency condition that is not related to your
life-threatening illness, you may want to consider CPR. However, the cause is
not always obvious when a person's breathing or heart stops.
to your doctor about your medical condition and the possible benefits of CPR
and life support.
What are the risks of CPR and mechanical ventilation?
People in a frail condition who receive CPR, mechanical ventilation, or
both generally do not have results as good as people who are healthy.1 Ribs can be broken from the chest compressions in CPR. A lack
of oxygen to the brain, which can occur when the heart stops, may lead to brain
damage. Although CPR may revive you and mechanical ventilation may sustain your
life, you may not be able to return to the life you had prior to receiving life
CPR and mechanical ventilation may reduce your chance of
a calm, peaceful death. Although your life may be prolonged, your remaining
time may be spent in a hospital connected to a life-support machine. Some
people fear a loss of dignity at the prospect of being in such a state.
If you have not communicated your wishes about CPR and mechanical
ventilation and your breathing or heart stops, your doctor and family may face
difficult decisions. In an emergency situation, CPR probably will be started.
After CPR is started, you may be placed on a ventilator if you are unable to
breathe on your own, even if you do not want to be placed on a ventilator. If
you have not communicated your wishes, your doctor and family may have a
difficult time deciding how aggressively to continue your medical care. Also,
it may be very difficult for your family to determine when to remove the
What are the risks of not receiving CPR and mechanical ventilation?
CPR and mechanical ventilation focus on prolonging
life. If you choose not to receive CPR or mechanical ventilation and your
breathing or heart stops, your breathing and heart may not start again and you
may die. Even though you have been diagnosed with a life-limiting illness, your
death may happen unexpectedly, which can be traumatic for family members who
may need an opportunity to say good-bye.
If you are facing a
life-limiting illness and choose not to receive CPR and mechanical ventilation,
communicate this clearly to your doctor and family. Many states require a
doctor's order to release paramedics and other health professionals from the
obligation to start resuscitation. Ask your doctor about a "Do Not Resuscitate"
order. Be specific about your wishes. Use this time to share your feelings
about not wanting to prolong your life. This time can be an opportunity to
share memories, nurture your relationships with others, and say good-bye. If
your death happens quickly and unexpectedly, your family may feel assured that
you received the medical care you wanted and you died in the manner you
If you need more information, see the topic
Care at the End of Life.