CPR Form

You are being presented with this form because your pet is a patient at Orchard Park Veterinary Medical Center (OPVMC) and we would like to know your wishes in the event of a cardiopulmonary arrest (CPA) (if the heart stops beating and/or your pet stops breathing).

CPR means “Cardiopulmonary Resuscitation” and is the treatment of a pet who has stopped breathing or whose heart has stopped beating (regardless of the cause). CPR includes but is not limited to:

• External chest compressions
• Use of advanced monitoring equipment, such as ECG and end tidal CO2
• Assisted ventilation and supplying oxygen (typically with placement of an endotracheal tube)
• Placement of an IV catheter
• Giving medications
• Defibrillation (if indicated by ECG diagnosis)

There are some potential risks associated with CPR and we feel it important to review:

Injury Risk: CPR may cause trauma such as fractured ribs, bruising, and internal injuries

Neurological Damage: Because of the lack of oxygen during an arrest event, there is a risk for brain damage, and your pet may not fully recover even with successful resuscitation

Success Rate: Some pets may not respond to CPR or may respond initially and then suffer another arrest later. Many pets may die despite CPR. Reports from veterinary hospitals suggest that CPR survival in dogs and cats undergoing CPR is low and ranges from 5% to 7% in dogs and 1% to 19% in cats. Evidence has shown that dogs and cats experiencing CPA in association with an acute, reversible cause such as anesthesia are significantly more likely to survive.

There are also financial costs associated with CPR. The initial costs for CPR are approximately $450. If CPR is successful, an ongoing treatment estimate and care estimate will be provided. Payment is due at time of service and deposits equal to 75% of the higher end of the estimate range are required for admittance to the hospital.

DNAR means “Do Not Attempt Resuscitation” This means that if a pet stops breathing or his/her heart stops, no effort will be made to attempt to revive the pet, and the pet will die.

I HAVE READ AND UNDERSTOOD THE INFORMATION ABOVE OR HAD IT EXPLAINED TO MY SATISFACTION.

I understand that if the OPVMC staff is unable to reach me within 15 minutes after the initiation of CPR procedures, and after exercising reasonable medical judgment, if a veterinarian determines that there appears to be virtually no hope for medical success, then further CPR procedures will cease. I consent to CPR and any costs associated with the resuscitation efforts.