you know that the real problem is not the resuscitation of people who are essentialy dead but the care that they receive in these so called nursing homes which leads to these kind of resus decisions. As you've already illustrated in your blog the likelihood of a successful revival is limited to the effort given in the initial collapse. The new ALS guidelines emphasise the importance of bystander CPR and those of us in the resus room have to consider the presence of 1: The absence of bystander CPR 2: Asystole throughout The fact is are you and myself are aware the quality of care provided by nursing home staff is sometimes pathetic, however there may be an argument for DNR decisions to be carried forward in those people who are unlikely to benefit from any kind of intervention after discharge from hospital.