Do not attempt CPR decisions

Why is the programme required?
A report by the British Medical Association, Resuscitation Council (UK) and the Royal College of Nursing highlighted that ‘Cardiopulmonary resuscitation (CPR) was introduced in the 1960s as a treatment that for some people may restart their heart when they suffer a sudden cardiac arrest due to a heart rhythm disturbance, most commonly triggered by acute myocardial infarction (‘heart attack’) from which they would otherwise have been expected to make a good recovery. The context of sudden cardiac arrest in a person with a heart condition remains the situation in which CPR is most likely to be successful. The probability of success in any individual is influenced by other factors and in many people with advanced chronic disease the likelihood of CPR being successful is relatively low.

CPR involves chest compressions, delivery of high-voltage electric shocks across the chest, attempts to ventilate the lungs and injection of drugs. The cessation of the heartbeat and/or of breathing is an integral part of the natural process of dying from any cause.

As awareness of CPR increased and resuscitation equipment became more widely available and more portable, attempts at CPR became more common in situations other than a sudden cardiac arrest due to a heart attack. These included circumstances in which people were gravely ill, and in which attempts to re-start their heart either would not work, subjecting them to violent physical treatment at the end of their life and depriving them of a dignified death, or might restore their heart function for a brief period and possibly subject them to a further period of suffering from their underlying terminal illness.

It was therefore recognised that, whilst there were some circumstances in which CPR could restore a person to a period of what the person considers a worthwhile life, there were other circumstances where attempting to prevent a natural and inevitable death could do harm. Anticipatory decisions about CPR were recognised as the way to try to ensure that dying people were not subjected to the trauma and indignity of attempted CPR with no realistic prospect of benefit.’

In the East Midlands there are a number of different approaches to recording and communicating Do Not Attempt CPR decisions across health and social care settings. There is evidence that patients and their families and carers are being expected to discuss their wishes more than once as previously recorded decisions are not shared in a suitable manner.

The Resuscitation Council UK has identified several problems including:
  • Reluctance to discuss CPR
  • Poor communication with patients and their families but also between health and social care professionals
  • Variation in recording Do Not Attempt Cardio Pulmonary Resuscitation decisions
  • Individuals being subjected to inappropriate CPR attempts
  • Evidence that a DNACPR decision results in individuals receiving poorer care.

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