CPR not always good, say new ICMR norms

NEW DELHI: Cardiopulmonary resuscitation (CPR) cannot and should not be done in certain circumstances, say the ICMR’s consensus guidelines on Do Not Attempt Resuscitation (DNAR) published in the Indian Journal of Medical Research. The guidelines, a first in India, state that the decision on whether to perform CPR or to allow natural death is the clinician’s responsibility.
The guidelines have been drawn up by a committee set up for the purpose by ICMR. They state that in certain circumstances doing CPR could increase suffering for patients, like those who have serious terminal illness, without offering the prospect of a reasonable quality of life even if they are revived.
“When performed in time on a relatively healthy patient, it can be life saving. But if done on already seriously ill patient or if the procedure begins late for any reason, then it may not succeed. In fact it can lead to a terrible situation: the heart restarts but the brain is badly damaged by loss of blood circulation for a crucial period of time. In frail, ill and elderly patients, it can be both a traumatic and useless exercise, leaving behind broken ribs and unnecessarily prolonging death,” said a statement issued by ELICIT, End of Life in India Task Force formed by three professional societies—the Indian Society of Critical Care
Medicine, Indian Association of Palliative Care and Indian Academy of Neurology.
The guidelines mark a break from the past for Indian medicine. “For the past 5 decades, Indian doctors have been conditioned to believe that CPR must always be done when the heart and breathing stop. The unstated assumption has been that if CPR is not done, even in a dying patient, this is potentially liable for legal action. This is contrary to current practice in most of the world. Today’s publication clears up this ambiguity,” said the ELICIT statement.