Information for patients and their carers to support discussions about CPR
 

While the decision to resuscitate is a medical one, it can be made with your wishes in-mind. But this is only possible if your wishes are known in advance.

This leaflet has been written to help you consider whether you want to record your resuscitation wishes now, in anticipation of anything that may happen in the future.

This is a general information leaflet for everyone over 18 years of age with a life limiting health condition. The answers to some of the questions people most frequently ask are addressed in this leaflet. Your relatives, friends, carers and others who are important to you may also find this leaflet useful.

This leaflet may not answer all your questions about cardio pulmonary resuscitation (CPR), but it will help you to think about the subject and decide whether to make your wishes known and to record them.

If you have any other questions related to CPR, please talk to one of the healthcare professionals (doctors, nurses and others) caring for you.

Reading this leaflet, you will learn:
  1. What is cardio pulmonary resuscitation (CPR) and What a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR)  decision means 
  2. How you will know whether CPR is relevant to you
  3. How medical decisions about CPR are made - and how your wishes may influence this decision
What is cardio pulmonary resuscitation (CPR)?

When a person’s heart and breathing has stopped, we call this “cardio pulmonary arrest”.

This can happen as a result of a very sudden event caused by a condition such as a clot lodging in the heart or lungs or following an abnormal heart rhythm. It can also be the result of general deterioration which occurs during the normal process of dying.

When a cardio pulmonary arrest happens, it is sometimes possible to restart the heart and breathing with an emergency treatment called CPR.

CPR usually includes repeatedly pushing down very firmly on the chest to pump blood from the heart around the body. Sometimes, a defibrillator is used to electrically shock the heart to start it beating normally again. CPR also includes mouth to mouth breathing, or using a mask over the nose and mouth, or a tube inserted into the windpipe through which the lungs can be artificially inflated.

DNACPR refers to a decision to allow natural death and to prevent attempts to restart the heart using CPR.

How you will know whether CPR is relevant to you

The health professionals caring for you are the best people to discuss your likelihood of having a cardio pulmonary arrest, as it depends on your medical condition. The chance of CPR reviving you will depend on why your heart and breathing have stopped and any illnesses or medical problems you have. It also depends on how quickly your heart and breathing can be re-started after the cardio pulmonary arrest has occurred.

On average, only 4 out of 10 patients whose heart and breathing have stopped can be revived by CPR. Of those 4 patients, only 2 will then survive long enough to be able to leave hospital. For people with serious underlying medical conditions or for those not already in hospital, the likelihood of survival is much lower.

Neither age nor disability are by themselves important factors when considering CPR, but your current state of health is important. Everybody is different, which is why you need to discuss with your healthcare team what CPR is likely to do for you. Your current wishes, and the likelihood of CPR being able to help achieve what you want, can then be considered.

Most attempts at CPR, especially when the arrest is due to the deterioration of other serious medical conditions, fail to restart the heart.  Of those people who do survive, the majority will have continuing health problems and many will remain very unwell and need intensive care. Some may suffer long term brain damage and/or remain in a coma from which they never recover. Some may experience additional side effects from the CPR itself, such as bruising, fractured ribs and punctured lungs.

Therefore it is important for you and your health professionals to discuss a plan in the event of a cardio pulmonary arrest.

If you feel you have not had the chance to have an in-depth discussion with your care team, or you are not happy with the discussions that have taken place, you have the right to ask for further information and support.  

How medical decisions about CPR are made - and how your wishes may influence this decision

Where no wishes have been expressed and recorded to the contrary, the normal action is to immediately start CPR.

If nearing the end of your life through illness, there will be no benefit in trying to resuscitate you as the heart and breathing are stopping as a natural part of dying. In these circumstances, it is more important to maintain pain control, comfort and dignity. CPR may offer false hope and do more harm than good by not allowing a natural peaceful death.

If it is decided that CPR should not be attempted a DNACPR form will be completed and recorded within your medical records.  The healthcare team and, with your consent, the family and friends you want involved, will be made aware of the decision and in the community the completed form will be kept in the your home. In North Cumbria we use the Deciding Right DNACPR form to record this information.

It is important to know that a DNACPR decision only applies when your heart and breathing stop. It does not affect any other treatments that you might need. The healthcare team will therefore continue to give you the best possible care in all other respects.

Whilst you cannot demand CPR, clinicians should always listen carefully to your wishes and your views on what constitutes quality of life for you.

If you are not happy with their recommendations, you may ask for a second opinion from other senior health care professionals. If your clinical team considers CPR would not be appropriate in your circumstances, they are not obliged to attempt resuscitation. .

In order to ensure your wishes are legally binding, you should make a written “Advanced Decision to Refuse Treatment” (ADRT) which is a statement made by a mentally competent person aged over 18 years which defines in advance their refusal of specific medical treatment should he/she become mentally or physically incapable of making his/her wishes known. This is (if valid and applicable to the situation) legally binding even if the chances for recovery are good.

If you need to talk about this with someone outside of your family, friends or carers, you may find it helpful to contact any of the following:
  • Patient Advice and Liaison Service (PALS)
  • Spiritual carers, such as chaplain
  • Your GP
  • Your Clinical Nurse Specialist
  • Your District Nurse

You don’t have to discuss CPR if you don’t want to, in which case a senior clinician involved in your care will decide whether CPR should be attempted and, with your consent, will discussed this with those closest to you. If you have appointed a person with Lasting Power of Attorney (LPA) for Health & Welfare, they can represent your views if and when you lack capacity.

If there are people you do (or do not) want to be consulted, you should let you care team know. Your family and friends do not hold the authority to act on your behalf, unless you have given them Lasting Power of Attorney for Health & Welfare.

In summary

There is a legal requirement to explore your views wherever possible regarding DNACPR, however the decision to offer CPR is clinical and rests with the clinician.

In hospital, if you don’t have a DNACPR order, attempts will be made to resuscitate you until the senior clinician in charge of your care decides if this is the most appropriate action.

If an arrest occurs in the community and you don’t have a DNACPR order, an ambulance will be called and an attempt will be made to resuscitate you and bring you into hospital.

Sometimes restarting a person's heart and breathing will leave them with a severe disability or prolonged suffering, so preserving life in these circumstances is not always beneficial.

Your healthcare team will also want to look at all the medical issues, including whether CPR is likely to re-start your heart and breathing based upon your general condition and a consideration as to whether it might prolong your life in a way that you can enjoy.

For more information on CPR, you can contact us:

Resuscitation Team, Penrith Hospital Bridge Lane, Penrith CA11 8HX Tel: 01768 245932

http://cptportal.cumbria.nhs.uk/SiteDirectory/Resuscitation/Pages/Resuscitation.aspx

For more information on The Mental Capacity Act please refer to:

www.dca.gov.uk/legal-policy/mental-capacity/ publications.htm

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302