People significantly overestimate the success of CPR and underestimate the negative impact it can have on their health. Most everyone believes that CPR is relatively successful with most patients surviving out-of-hospital cardiac arrests, according to the Journal of Emergency Medicine. Those interviewed estimated success at more than 75% in all situations and 90% said they wanted to receive CPR if necessary. The actual rates of survival are about 8-12% out of hospital and 25 to 40% in hospital. Furthermore, CPR must be rigorous to be successful and strong compressions often break chest bones. These bones can bruise or puncture the lungs or the heart. The JEM suggests that people probably think CPR is so successful because they see so many happy outcomes in television medical dramas.

Physicians estimate rate of survival for patients who undergo CPR in the hospital as roughly 15% . However, if CPR is done immediately out of the hospital the chances of survival are improved if CPR as long as it is administered within 4 minutes after cardiac arrest period. The American Heart Association estimates that depending upon the rigor of the CPR event outside the hospital, about 40% of persons survive long enough to get to the hospital; however, survival rates to discharge are only about 13 to 15% among heart patients and only about 2% among cancer patients. Moreover, most survivors will suffer brain damage after three or four minutes. Broken ribs and damaged organs are common problems associated with CPR.

Other problems include complications caused by intubation and ventilation, often occurring in the hospital after CPR. These procedures can damage teeth, voice box, or lungs, cause pneumonia or even a collapsed lung. The most frequent problems that arise are aspiration and vomiting. When the content of the stomach comes up, you can end up inhaling them through your nose.

The abdomen usually becomes distended, making ventilation more difficult because the lungs compress and pneumonia can result. Aspiration induced pneumonia is very dangerous, even fatal. If CPR works, your lungs may be weak and you will need to be on a breathing machine and cared for in an ICU. It can take up to 6 months to recover from CPR. If you do not want it, you must make file a DNR with the hospital and your doctor. Obviously, you need to consider whether CPR is right for you, especially if you have a life-threatening illness.

If you are at home when the problem develops, EMTs must administer CPR by law. So, you need a POLST: Physician’s Order that directs EMTs not to engage in CPR if you don’t want them to do that. You will need your Physician to sign the POLST and you will need to post it in an obvious location. Most people post the Physician’s Orders on the refrigerator, but one of my clients at Hospice posted hers on the front door. She wanted them to see it even before they came in.

Autopsies show that about 30% of people who received CPR and died, had fractured ribs. Of those who survived CPR, 17% experienced cognitive impairment and 16% reported depressive symptoms. Hope West, a hospice organization in Colorado, estimates that only 1% of patients with serious illnesses can survive CPR.

If you are young, of course, you will want to have every chance to survive, even if it requires CPR. On the other hand, if you are elderly and you have been diagnosed with a terminal disease, you may not be so eager to have people save your life while breaking your ribs and increases your chances of pneumonia. Advanced directives need to be reviewed every few years as you age and should be considered as young as 16. Many states ask you whether you want to be an organ donor when you get your first driver’s license. Take this as an opportunity to talk with your children about what they might want if they are in a terrible accident and need heroic measures to survive.

Once you have decided that you don’t want CPR, you need to be sure that your healthcare agent understands your wishes and is willing to fight for them. In the hospital, doctors and nurses are dedicated to keeping you alive, so it’s important for your healthcare agent to be clear, persistent, and insistent about what you do and do not want.