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Information about resuscitation discussions and decisions

Cardiopulmonary resuscitation (CPR), Information for patients and their families

This information is for patients, their families and friends. It explains:

- What cardiorespiratory arrest is (sometimes called “cardiac arrest” or just “arrest”)

- Cardiopulmonary resuscitation (CPR) as a treatment for cardiac arrest

- How it may apply to you

- How decisions about it are made

The doctors or nurses looking after you will be happy to discuss any questions you have about CPR.

What are cardiorespiratory arrest and CPR?

Cardiorespiratory arrest means that a person’s heart and breathing have stopped. Put simply, it is the moment at which that person has died. (This is not the same as other serious events such as heart attack, collapse or coma, which are treated differently). When cardiorespiratory arrest happens, it is sometimes possible to restart the heart and breathing with emergency treatment called CPR (cardiopulmonary resuscitation – sometimes just called “resuscitation”). This can include:

- Mouth to mouth or mask to mouth breathing

- Repeatedly pushing down very firmly on the chest (chest compressions)

- Delivering electric shocks to the heart with a machine called a defibrillator (this is only

suitable for certain types of cardiorespiratory arrest)

- In hospital a mask or tube can be inserted into the windpipe

through which oxygen is pumped into the lungs. Intravenous drugs can also be given.

Any patient whose heart is successfully restarted needs immediate transfer to hospital for care, usually in an intensive care unit.

How successful is CPR?

The media sometimes present CPR as being very successful. In fact, CPR usually only works in certain situations. People who were previously in good health and have specific types of cardiorespiratory arrest are much more likely to respond to treatment. Only one in eight people (with all kinds of illness) who receive CPR in a hospital with all the available facilities will recover enough to leave hospital.

A person’s chances of surviving CPR very much depend on how well they were before the cardiorespiratory arrest. In people with very serious, advanced illness such as advanced cancer, heart or lung disease, only about one person in a hundred who receives CPR will recover enough to leave hospital.

Are there side effects or complications of CPR?

CPR can sometimes cause broken ribs, punctured lung or internal bleeding. A person who survives CPR is often still very unwell and may suffer brain damage or go into a coma. Unfortunately a lot of patients never recover the level of physical or mental health they had before the cardiorespiratory arrest.

What does CPR mean for patients like me?

Sudden cardiorespiratory arrest is relatively uncommon. For most people, the heart and breathing slow down gradually over hours or days after a period of worsening illness, they become more sleepy and their death is natural and expected. Treatments such as antibiotics, painkillers or drips will all still be given where appropriate, along with everything possible for that person’s comfort. If a decision is made not to offer CPR (called a DNACPR decision or Allow a Natural Death), its purpose is to avoid unpleasant treatment which has little chance of success, and to allow a dignified and peaceful death in due time.

Who makes the decision about resuscitation?

If there is a chance CPR may succeed, your doctor/ nurse will offer to discuss it with you and will take your wishes into account. You do not have to talk about it if you do not want to. The aim of this discussion is to make a calm decision in advance so that there is a clear treatment plan. If you decide that you definitely would not want CPR, your wishes will be respected whatever your state of health. With your permission, CPR can be discussed with your family or friends, but they cannot make decisions about it for you unless you are no longer able to do so and they are your appointed Lasting Power of Attorney.

How is the CPR decision recorded?

The decision is recorded on a form with a red border for you to keep at home, so that all staff looking after you are clear about your care plan. A copy is also kept on your GP’s records. The ambulance service is also informed, so that if cardiopulmonary arrest happens at home, ambulance staff can offer appropriate support instead of CPR.

What if I have questions or worries?

Doctors and nurses will be happy to discuss CPR with you at any stage of your illness and, with your permission, with your relatives or friends.

Resuscitation decisions  
Resuscitation council UK   A leaflet about Cardiopulmonary Resuscitation (CPR) and how decisions are made about it.  
https://www.resus.org.uk/sites/default/files/2020-06/2016_07_25_CPRdecisions_patientinfo_FINAL.pdf  
Dying Matters  
A leaflet to help you have a conversation with a health or social care professional about your preferences for your end of life.  
https://www.dyingmatters.org/sites/default/files/DNACPR%20Patient%20leaflet_A4.pdf