CPR LAWS

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Does anyone know what the law or statue is for this scenario:

provider wants to stop CPR, no DNR on file, family wants CPR to continue and refuses to sign DNR. What should the nurse do? Please help with this! I have been googling all over the place for help with this answer!

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Specializes in Nurse Leader specializing in Labor & Delivery.

There is no law that would address it. The question is: what is a sensible amount of time to administer CPR/ACLS before "calling" it? Good luck with your homework!

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In the scenario the patient has coded 5 times. EEG was performed and no brain activity. The provider is wanting CPR to stop but the family says keep going.

I keep seeing conflicting results that there has to be 2 providers to state that the patient is brain dead, but what if the family keeps saying do it. Do you do it and get in trouble by your job or do you stop and get sued by the family for stopping?

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No brain activity is brain dead I believe ( assuming no sedation was on board at the time), so barring organ donations, there is literally no reason to continue. Pt is already dead.

and if the doctor declares time of death, you can't really continue cpr. The family can try and sue, but the have no real legal grounds against you

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Specializes in retired LTC.

Just don't let anyone know about the care issues re Jahi.

That might be some interesting reading for your case.

Has anyone heard anything new about her?

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Specializes in Nurse Leader specializing in Labor & Delivery.

Let's not derail this thread. If you want to discuss that, let's start a new one.

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Specializes in Pedi.

Just because the family doesn't want to sign a DNR doesn't mean you keep doing CPR for hours and hours. You have attempted resuscitation. It didn't work. In this case, if the provider calls time of death, I'd stop. There are no real legal grounds for the family to sue here. It's not negligent to stop CPR on someone with no brain activity for whom all resuscitative measures have been exhausted.

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In the scenario the patient has coded 5 times. EEG was performed and no brain activity. The provider is wanting CPR to stop but the family says keep going.

I keep seeing conflicting results that there has to be 2 providers to state that the patient is brain dead, but what if the family keeps saying do it. Do you do it and get in trouble by your job or do you stop and get sued by the family for stopping?

There is absolutely nothing about needing two physicians to declare someone brain dead when CPR is in progress.

When those involved in the resuscitation have performed the interventions that are/were appropriate and (usually what I'm used to is that) all agree that every remotely reasonable intervention has been done - we stop/ToD is called.

Someone not saying that they don't want to be resuscitated doesn't mean that others can force a resuscitation team to perform acts upon them after they are deceased.

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If someone is in cardiac arrest ans receiving CPR, why is brain death even a consideration?

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Specializes in SICU, trauma, neuro.

Well if the physician calls it, even if you continued compressions there's an impending limit. I mean if the pt is in asystole, compressions will keep circulation going for a bit, but even with a Lucas it can't go on forever... hours at best, but not days or weeks. At some point that pt will need defibrillation & drugs, or successful treatment of underlying cause or a pacemaker -- inappropriate for a deceased person.

It's true that confirmatory brain death testing is done by two MDs, independent of each other... I'm assuming the child is on a ventilator though? If one is brain dead, the heart will continue as long as it's receiving O2 because of its intrinsic electrical ability -- unlike other vital functions which require brain stem function.

However if the child is pulseless, it's not a question of brain death or not. If ROSC is not achieved, that is CARDIAC death and not dependent on the results of brain death testing.

It's horrible in any case...I can't even imagine. As parents you want nothing more than to protect your child. Once I actually ran into the path of an oncoming car after my toddler wandered into the street (little guy is FAST!!). I can honestly say in that moment my ONE thought was "save my baby!!" I'm sure they want to save theirs... but here all they can do is plead with the staff to keep going.

But the child is already gone.

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

I believe since the patient is essentially dead the physician can legally stop CPR and all resuscitation efforts, even if the family wants them to continue.

If every ER/floor continued CPR until the family said stop our healthcare costs would be astronomical and there would always be someone receiving CPR! The patient is dead, they are brain dead.

As the RN you are bound by the physicians orders to stop resuscitation, thus the argument of whether to continue is between the family and the doctor!

Also it sounds like the family is still in the denial phase and needs someone such as an RN not involved in the code, a chaplain, or maybe the nursing supervisor to talk to them and let them know that their loved one is dead.

Annie

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Specializes in Critical Care.

CPR is a medical intervention, so a Physician is expected to determine when it is futile and discontinue it when indicated, this can be during or before a patient codes. It's not appropriate or a good idea in terms of liability to abuse a patient just because family wants you to. I

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