Full name:
Medical Record #:
2. CPR (Cardiopulmonary resuscitation)
CPRisanattempttobringyoubacktolifewhenyourheartandbreathinghavestopped.It
may include chest compressions (forceful pushing on the chest to make the heart contract),
medicines, electrical shocks, and a breathing tube.
YouhaveachoiceaboutCPR.CPRcansavelives.Itisnotaseectiveasmostpeoplethink.
CPR works best if done quickly, within a few minutes, on a healthy adult. When CPR is
performed, it can result in broken ribs, punctured lungs, or brain damage from lack of oxygen.*
IfyouwouldlikeadditionalinformationaboutCPR,pleaserequestthe brochure called CPR:
Cardiopulmonary Resuscitation
IfyoudonotwantCPR,pleasediscusswithyourphysicianotherdocumentsyoumaywant
to complete.
In the event that your heart and breathing stop, what would you want?
❏
IalwayswantCPRattempted.
❏
IneverwantCPRattempted,butratherwanttopermitanaturaldeath.
❏
IwantCPRattemptedunlessthedoctortreatingmedeterminesanyofthefollowing:
• Ihaveanincurableillnessorinjuryandamdying;or
• Ihavenoreasonablechanceofsurvivalifmyheartorbreathingstops;or
• Ihavelittlechanceofsurvivalifmyheartorbreathingstopsandtheprocessof
resuscitationwouldcausesignicantsuering.
Choose
One
* Research shows that if you are in a hospital and get CPR, you have a 22 percent chance of surviving and leaving the
hospitalalive.SaketGirotra,M.D.,BrahmajeeK.Nallamothu,M.D.,M.P.H.,JohnA.Spertus,M.D.,M.P.H.,etal.“Trendsin
SurvivalafterIn-HospitalCardiacArrest;”New England Journal of Medicine367;20November15,2012.
Need additional assistance?
kp.org/lifecareplan
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