Decisions relating to cardiopulmonary resuscitation (CPR)

"All establishments that face decisions about attempting cardiopulmonary resuscitation (CPR) including hospitals, general practices, care homes and ambulance services, should have a policy about CPR attempts. These policies must be readily available and understood by all relevant staff."

This extract is taken from Decisions relating to cardiopulmonary resuscitation
A joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing - October 2007       http://www.resus.org.uk/pages/dnar.pdf

The overall clinical responsibility for decisions about CPR, including Do Not Resuscitate (DNAR) decisions, rests with the most senior clinician in charge of the patient's care.  This may be the GP but, even when another clinician takes overall responsibility, the GP may be required to provide input into the decision-making process.

Decisions about CPR must always be based on an individual assessment in which good communication and information is essential.  It is not necessary to initiate discussion about CPR with a patient if cardio-respiratory arrest is unlikely, but advance planning is important for those at risk of cardio-respiratory arrest.

Where no explicit advance decision has been made there should be an initial presumption in favour of CPR, unless it is unlikely to re-start the heart and breathing or the expected benefit may be outweighed by the burdens.

CPR should not be attempted if a patient with capacity refuses CPR, or a patient lacking capacity has a valid and applicable advance decision.  

DNAR decisions apply only to CPR and it is essential that normal daily care and treatment of the patient is not affected by a DNAR decision.

All GPs should understand the principles involved in assessing a patient's mental capacity in relation to DNAR decisions and whether CPR should be attempted. 

This joint statement on these issues is recommended as easily accessible and authoritative advice on the subject.

See also Wessex LMCS Guidance on the Mental Capacity Act.

CED 8/9/08