Decisions about cardiopulmonary resuscitation (CPR)
Treatment planning for seriously ill patients
Cardiopulmonary resuscitation (CPR) is when we try to start someone's heart and breathing again if they have stopped unexpectedly.
CPR works well for people who were reasonably healthy before. However, it is unlikely to help people who are frail or have a background of poor health.
CPR will not be successful for people naturally approaching the end of their life. It is likely to prevent a peaceful and dignified death. In some cases, CPR can prolong dying or suffering and cause harm (such as broken ribs or damage to internal organs).
Do not attempt CPR (DNACPR) decisions
It's important for us to decide whether CPR is right for you or your loved one. We might recommend a do not attempt cardiopulmonary resuscitation order (a DNACPR) if we believe that CPR is not right for you. This can also be called DNAR (do not attempt resuscitation) or DNR (do not resuscitate). They all mean the same thing.
We write the DNACPR in your hospital notes and give you a paper copy that you can take home with you.
If you do not agree with the decision, you can ask for a second opinion.
A DNACPR decision is about CPR only and you get all the other treatment that you need. Many people think about their wishes for resuscitation and levels of treatment that are acceptable to them before coming into hospital. If you have thought about these issues, please tell us.
Cardiopulmonary resuscitation, usually called CPR, is a treatment used to try and restart somebody's heart when it stops unexpectedly. It's a treatment that involves pushing blood around the body by giving chest compressions, which involve pushing very hard on the centre of the chest, blowing air into the lungs with a special bag, usually via a tube that's inserted into the airway, and sometimes we will also give drugs, which are given either through a vein or sometimes using a special needle put into the bone, and electricity to try and get the heart restarted. CPR works best in people who were relatively well before their heart stopped. It doesn't work very well in people who are very frail or who have a lot of underlying medical problems, which make it unlikely that we can resuscitate them successfully.
Because it can cause pain, discomfort and distress, it's important to identify those who won't benefit from the CPR to protect them from receiving it. CPR is not a treatment for ordinary peaceful dying.
CPR is something that you can talk to us about at any time and we will always talk to you about it if there are concerns as to whether it is an appropriate treatment for you. If you disagree with any decision that's made, you can request a second opinion.
It's possible that you won't be able to discuss your wishes and beliefs about CPR with the medical team because you're too unwell. If that happens, the medical team will talk to those who are important to you about it. That means it's very important that you have talked to your family and friends about your wishes and beliefs, so that the medical team can gather as much relevant information as they can before they make their decision.
If you've made an advance decision to refuse treatment, a living will, that applies to CPR, you must tell the team looking after you. If you've appointed a lasting power of attorney for health, this person can refuse CPR on your behalf but they can't request it if we think that it might fail.
When CPR is not going to be given, the doctors looking after you will fill in a form. This is called a 'do not attempt cardiopulmonary resuscitation' order, or a DNA CPR order. This is a communication tool that informs everyone who's looking after you that we're not going to give that treatment. If you are going home, they will give you a copy of the form to keep at home. It's very important that health care providers who are coming into your home to give treatment are aware of that order.
DNA CPR applies to CPR only. You can still come into hospital and receive all other forms of treatment. Please talk to your healthcare team for more information.