Deciding On CPR Options Before A Medical Crisis

If you have an advanced or life-limiting illness, you may have decided you don’t want to be resuscitated if your heart stops. But this wish cannot be honored without an important document — the Medical Order for Life-Sustaining Treatment (MOLST). In some states, including Maryland, emergency responders and other medical personnel are required to perform CPR when a heart stops unless they’ve seen the patient’s MOLST signed by a physician, nurse practitioner or physician’s assistant stating that CPR is not to be performed.

The form addresses other life-sustaining measures such as dialysis, transfusions and antibiotics, so it’s important to thoroughly discuss it with your provider. Download it at www.whymolst.com/resources. In this article, we’re going to review Section 1, which addresses resuscitation.

The first option in Section 1 is “Attempt CPR.” This means that all comprehensive efforts will be made in the event of a cardiac arrest. Responders will perform chest compressions and they may place a breathing tube, administer medications or defibrillate, using electricity to try to restart the heart.

Section 1’s next option is “No CPR, Option A, Comprehensive Efforts to Prevent Arrest.” This means all comprehensive efforts will be made to prevent cardiac arrest, but there will be no chest compressions if cardiac arrest occurs. Option A is further broken down into two choices: “Option A-1, Intubate” or “Option A-2, Do Not Intubate (DNI).”

Selecting Option A-1 means a breathing tube can be placed into your airway and you can be placed on a breathing machine. Selecting Option A-2 means they won’t place a breathing tube but can use a CPAP or BiPAP machine to help with breathing. These devices force air through a mask that covers the nose or nose and mouth to keep the airway open. With both options, they will not perform chest compressions.

The final option is “No CPR, Option B, Palliative and Supportive Care.” Should your heart stop beating, the medical team would make sure you’re comfortable and free from any disturbing symptoms like pain and anxiety. They might provide passive oxygen through a nasal cannula, but they wouldn’t intubate or use CPAP or BiPAP.

Electing the “do not resuscitate” option doesn’t mean your medical team will stop all treatment. They will continue treating you but will not perform CPR if your heart stops. Instead of thinking of DNR as “do not resuscitate,” consider it to mean “die naturally with respect.”