New guidance on decision-making in CPR

NEW guidance on making decisions about attempting cardiopulmonary resuscitation (CPR) has been published.

Such decisions can be very distressing for patients and people emotionally close to them and they need to be handled carefully and sensitively. The revised edition of Decisions relating to cardiopulmonary resuscitation has been issued by the BMA, the Resuscitation Council (UK) and the Royal College of Nursing (RCN). The guidance has been reviewed and updated, taking into account developments in clinical practice and law regarding decisions about CPR.

The new edition emphasises the value of making anticipatory decisions about CPR as an integral part of good clinical practice. CPR as a default position denies patients the "opportunity to refuse treatment that for many may not offer overall benefit and that many may not want".

Dr John Chisholm, Chair of the BMA’s Medical Ethics Committee, said: "It can be difficult to talk to patients or their family about the circumstances in which it may not be appropriate to attempt re-starting someone’s heart. However as doctors, it is our primary role to benefit patients and when treatment can no longer achieve this, it is right to avoid invasive and burdensome interventions that will not be successful.

"The reality is that cardio-respiratory arrest is part of the final stage of dying. Although it’s often portrayed on TV and film as a miraculous intervention that saves patients’ lives and reunites them with their loved ones, the truth is it carries the risk of internal fractures, ruptures, and long-term brain damage. Sadly, the survival rate is relatively low, and health professionals must be honest with their patients about the level of recovery that will be expected if CPR is attempted.

"These guidelines identify the key ethical and legal issues that should inform all CPR decisions. The basic principles are the same for all patients, in all settings, but differences in clinical and personal circumstances make it essential that all CPR decisions are made on an individual basis."