Resuscitation Preferences

Discussing resuscitation preferences is important for patients with advanced illness and advanced frailty who are appropriate for MOLST. A thoughtful MOLST discussion begins with preparation for the discussion as outlined in step 1 of the 8-Step MOLST Protocol. Reviewing resuscitation and other life-sustaining treatment preferences is Step 7.

Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is intended to prevent sudden, unexpected death.  Unless there is a medical order to withhold CPR, all attempts to prolong life are provided in an emergency when a person experiences cardiac and/or pulmonary arrest (i.e. the heart stops or when breathing stops).

CPR involves artificial breathing and forceful pressure on the chest to try to restart the heart. It usually involves electric shock (defibrillation) and a plastic tube down the throat into the windpipe to assist breathing (intubation). It means that all medical treatments will be done to prolong life when the heart stops or breathing stops, including being placed on a breathing machine (ventilator) and being transferred to the hospital.

A medical order to withhold CPR is called a “DNR Order” and means “Do Not Attempt Resuscitation” and “Allow Natural Death.”  It does NOT mean Do Not Intubate (DNI) if a patient experiences respiratory insufficiency. It does NOT mean Do Not Hospitalize (DNH) and does NOT mean Do Not Treat.

CPR is not indicated in cases of terminal, irreversible illness where death is expected, or in certain medical situations where CPR is deemed ineffective. For many people resuscitation is unwanted, unneeded and impossible. Depending on the patient’s medical condition and preferences, CPR may be inappropriate, futile and undignified.

Conversations Based on Evidence

The success rate of hospitalized patients with advanced illness, multiple comorbidities and moderate frailty to terminal illness should be considered when having thoughtful MOLST discussions and making resuscitation and other life-sustaining treatment decisions in this patient group.

Survival Rates

Chronic Illness

Advanced Illness and Multiple Comorbidities

Advanced Frailty

Frailty is associated with adverse outcomes from in-hospital cardiopulmonary resuscitation.

TV Does Not Reflect Reality

Conversations Based on Evidence

Statistics to keep in mind when having discussions about CPR:


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