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.

What is the programme and its aims?
An emergency care and treatment plan working group was established by the Research Council UK in February 2015 at national level to work collaboratively and build on major work already undertaken. They are developing a national form to record anticipatory decisions about CPR and other life-sustaining treatment, and guide decision-making in an emergency situation in which the person lacks capacity.

A task and finish group has been formed in the East Midlands to address areas of unwarranted variation in the principles and processes around regional DNACPR decisions.

The group will support East Midlands health and social care organisations to:

  • Agree on a set of principles as an East Midlands region to reduce variation in the approach to making, recording and communicating DNACPR decisions.
  • Ensure that patients with a valid DNACPR decision receive appropriate care but are not subjected to inappropriate cardiopulmonary resuscitation attempts regardless of the care setting.
  • Facilitate communications between various care settings to highlight key issues and through discussions and sharing ideas propose sustainable solutions to improve quality of care for patients.
  • Act as a platform for sharing good practice and to advise and enable implementation in different organisations where appropriate.
  • Benchmark inappropriate CPR calls/attempts in patients with a valid DNACPR decision
How are we making a difference?
The task and finish group is revisiting previous policies and procedural guidelines to update them for use across multiple health and care settings and considering the support required to communicate them across the region.

The group will develop guidance for staff working in care homes to provide the right support to their residents who have made a DNA CPR decision.

Who to contact for further information?
For more details, please contact This email address is being protected from spambots. You need JavaScript enabled to view it..