Information about CPR and Do Not Attempt CPR

My name is Sue Morgan, and I am one of the palliative medicine consultants here in Swansea Bay.

Thinking about attempting resuscitation is something that we often shy away from until either we are unwell, or someone close to us is critically ill.  We may hear terms like CPR and DNACPR or sick enough to die.  But what does all of this mean?

There is frequently misunderstanding about CPR (cardio pulmonary resuscitation), DNACPR (Do not attempt CPR) and allowing a natural death.  These misunderstandings can often cause patients and families distress, particularly when being discussed quite soon before a loved one dies.  As well as taking focus away from the important conversations that patients and their loved ones might want to have (like, thank you, forgive me; I forgive you and I love you), those left behind often feel a sense of guilt that they didn’t make the right choice for their loved one.

There is an All Wales policy on DNACPR that guides clinical teams when thinking about CPR and DNACPR or allowing a natural death.  The patient and public information booklet called Sharing and Involving, is linked to that policy.  We have added the information from that booklet, and from other patient information resources, below to help everyone living in Swansea Bay to understand the basics about CPR/DNACPR ready for when you need to have those conversations.

The most common misunderstandings are:

• That all treatment to help you return to good health stops when a DNACPR decision is made
• Attempts at CPR are always successful, returning everyone to good health, when it is successful
• The burden of responsibility about attempting CPR lies with the patient or their relatives

These, and other misunderstandings, are described in the information, and we hope that it will help clarify some of the common misunderstandings when it comes to decisions about whether to have an attempt at CPR, or if a decision not to attempt CPR (DNACPR) is better for you or your loved one.

If we can, it is better to talk about what is important to you early, before it is critical and before a decision needs to be made urgently. 

Of course, this is true about the treatments that may be offered to you before your heart and breathing stop, as well as the treatment that may be offered after the heart and breathing stop (that is CPR).

To help your clinical team to make the right treatment decisions for you it is essential that they know what is important to you.  It is also important that you know what the future might look like; how helpful treatment options might be; what the downsides of the treatment options might be.  Between you and your clinical team you can then work out what treatments fit in with what is important to you and what treatments may go against what is important to you.

Talking about this early on, when you are still able to tell us what is important to you is the ideal.  We often think that it is too early to discuss these things, and then it becomes too late to.

If there is anything in this information that you would like to know more about then please do ask your clinical team. They are there to help you understand what the options are for you, and whether or not you want to accept the treatments that are offered.