How to make decisions about life support

Advances in medicine and technology have enabled people to live longer – even when a cure is no longer possible. In these situations, decisions must be made about the use of emergency treatments to keep you in your current state. The doctors may use machines to do this. Decisions that your loved ones may need to make on your behalf may relate to CPR (cardiopulmonary resuscitation), use of a ventilator, tube feeding (or artificial nutrition and drips), and comfort care.

Cardiopulmonary Resuscitation (CPR)

CPR  is a medical intervention that may be performed if a person stops breathing or when their heart stops. It can include:

• Breathing into a person’s mouth and pressing onto his chest to enable his heart to start again.
• Electrical shocks to start the heart.
• Inserting a tube through the person’s mouth to aid his breathing.

Key points to remember about CPR: 

• CPR doesn't always work to resuscitate people, or "bring them back." And the older and sicker you are, the less likely it is to work.
• If CPR does work, you may have brain damage that affects your ability to talk, recognize loved ones, or take care of yourself.
• Studies have shown that a patient has a 17% chance of having a successful CPR and leaving the hospital alive. If the patient is older and weaker, the chances of a successful CPR is less than 3%.
• Outcomes of CPR include rib fractures, permanent brain damage, need to be on a breathing machine, and care in the Intensive Care Unit (ICU).
• Saying "no" to CPR and life support doesn't mean that you won't be taken care of. Doctors and nurses will always focus on making sure that you stay comfortable.

Tube feeding

Tube feeding is a way to deliver nutrients through a tube if the person cannot take food or drink through his mouth. It may be temporary or permanent depending on his medical condition. The person may have a tube that leads from the:

• Nose to the stomach (nasogastric tube – NG)
• Skin to the stomach (Percutaneous Endoscopic Gastrostomy - PEG)

Key points to remember about tube feeding: 

• Tube feeding causes discomfort due to the insertion
• Hand restraints may be needed to prevent accidental pulling of the tube.
• Chest infection is high due to the possibility of feeds entering the lungs instead.
• Swelling of the body may occur if the supplements cannot be absorbed as the body function shuts down.

Intubation

A person may require intubation if he is unable to breathe for himself. Intubation involves the insertion of a long breathing tube or artificial airway (endotracheal tube - ETT) into the trachea (windpipe) via the mouth. On some occasions, the tube may be inserted through the nose down into the trachea.

Key points to remember about intubation: 

• Intubation is invasive mechanical ventilation, which causes discomfort due to the insertion
• It will be impossible to eat or speak during intubation and tube feeding will be required.
• Medication can be given for pain or distress

Many people would rather leave this decision to loved ones, thinking that "they'll know what I would want." But that's very hard on your family. It's much easier and less stressful for them if you state your wishes clearly ahead of time. Hence, we will recommend you to do an Advance Care Plan (ACP) or Advance Medical Directive (AMD) to let your loved ones know of your preferences.

Also read: Advance Medical Directive (AMD) and Advance Care Plan (ACP)