Consent for CPR (Cardio Pulmonary Resuscitation) or DNR (Do Not Resuscitate)


Please take the time to read the following explanation. 

We understand that the topic of this consent form (CPR or DNR orders) may come as a surprise to you.  The staff at the VSCAN will make every effort to prevent complications arising from your pet’s illness/injury or procedures carried out in our hospitals.  However, in some cases, there is a risk that your pet may experience respiratory and/or cardiac arrest while hospitalized.  Cardio-pulmonary resuscitation (CPR) is a difficult subject for many people but one that is very important to review. All patients must have a resuscitation directive regardless of severity of illness. In the event that intervention is required, knowing your position on this sensitive matter allows our team to work more rapidly.  We ask that all clients read this, and we appreciate you taking the time to communicate your wishes in advance.  

 

You are being presented with this information because your pet will be hospitalized. The hospitalization length will vary depending on your pet’s needs and the procedures discussed at the time of consultation. Your pet's hospitalization may be short (day procedure) or long (multiple nights in hospital) depending on your pet’s situation. Even if your pet stays on the premises of the hospital for a single consultation, this information is vitally important for our team. The health and wellbeing of your pet, as well as the respect of your wishes, are always our priority.  


 

While your pet is hospitalized or under the care of the VSCAN or the Overnight team, your decision will reflect one of the following statements if you agree or disagree to CPR services.  


If you AGREE you are communicating the following:

"I authorize CPR/I wish for resuscitation to be performed on my pet should a cardiorespiratory arrest occur. I understand that this procedure will incur costs starting at 500$ and the total will vary depending on my animal’s needs (may be higher – we will update you as soon as possible with status and additional costs).  This and the cost of any additional care after the CPR are in addition to any other estimate or treatment plan recommended. This choice indicates that you authorize all efforts and procedures determined to be appropriate by the veterinarian to try to resuscitate your pet. CPR is more likely to be successful in a previously healthy, young patient and specific recommendations may be made by your veterinarian based on your pet’s condition. If CPR is effective, there are often problems that need to be addressed after resuscitation. CPR does not resolve any underlying diseases. I understand that my pet may not respond to CPR or may respond initially and then suffer another arrest later. I understand that my pet may die despite CPR. I understand that if my pet survives because of CPR, he/she may have residual issues, which will need additional care."


If you DISAGREE you are communicating the following:

"I do not authorize CPR/I do not wish for resuscitation to be performed should a cardiorespiratory arrest occur (DNR). After discussion with the veterinarian in charge, I would like every attempt to be made to prevent a cardiac and/or respiratory arrest from occurring, but if my pet undergoes arrest, NO CPR will be performed. (This option is always an acceptable choice based on your beliefs and needs)."


You must also understand that should you change your mind about the above decision, you must inform the veterinarian/team in charge of my pet as soon as possible.

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Additional information on CPR

 

Definitions:

 

CPR: means “CardioPulmonary Resuscitation” and is the treatment (resuscitation) of a pet who has stopped breathing or whose heart has stopped beating. Resuscitation of a pet who has stopped breathing but still has a heartbeat is more likely to succeed than resuscitation of a pet with no heartbeat. This may consist of chest compression, intubation to provide ventilation and administration of drugs to attempt return of spontaneous contraction of the heart muscle. This does not mean “open thorax CPR” as this requires an extremely invasive surgical procedure and this is rarely performed. 

 

DNR: means “Do Not Resuscitate.” This means that if a pet stops breathing or his/her heart stops, no effort will be made to attempt to revive the pet (eg. no chest compression, no intubation to provide mechanical ventilation, no administration of “emergency drugs”), and the pet will die.

 

The rate of survival to hospital discharge (return home) remains low compared to that of human CPR patients. Survival to discharge rates range from 1.6–6% in dogs, and 2.3–9.6% in cats, whereas in humans, approximately 12% and 24% of adults survive out-of-hospital and in-hospital cardiac arrest, respectively. Animals that have been successfully resuscitated are extremely critical and unstable. The likelihood of re-arrest is high and usually occurs within 4 hours of the initial arrest. If resuscitation is successful, there is a low chance that a pet will stay alive after resuscitation. The percentage of long-term survival is even lower, depending upon what caused the arrest. Brain or other organ damage is common due to temporary lack of oxygen to the brain, which can result in blindness and/or impaired mental function, leaving a pet with physical and/or mental disabilities which may last for days, weeks, or years. Even in human medicine, statistics show that less than 10% of patients who are successfully resuscitated will leave the hospital without some degree of brain damage (contrary to what television shows lead us to believe). 

Management of a pet after successful initial resuscitation requires vigilant intensive monitoring and intensive care for 24 to 48 hours. This care is costly and the outcome is uncertain because a pet will still have the underlying serious problem that led to the arrest; that disease or injury must also be treated as we attempt to stabilize the pet.