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Decisions related to CPR -new guidance published

The BMA, Resucitation Council and RCN have updated their joint guidance on the cardiopulmonary resuscitation - the guidance is available on the BMA website on the Ethics pages:
Second bullet under "C" http://bma.org.uk/practical-support-at-work/ethics/ethics-a-to-z
Direct link at http://bma.org.uk/media/files/pdfs/practical%20advice%20at%20work/ethics/decisionsrelatingresusreport.pdf

Click here for a local copy of Decisions relating to CPR 2014.pdf.

A BMA press release is also copied below.

Dr. Robert Morley
Executive Secretary
Birmingham Local Medical Committee

36 Harborne Road, Edgbaston, Birmingham B15 3AF

Tel. 0121-454 5008, Fax. 0121-455 0758
Office email: lmcadmin@blmc.co.uk
Website: www.blmc.co.uk
Birmingham Local Medical Committee
Supporting the Business of General Practice

BMA Press Release: Embargoed 00:01 Tuesday 7th October 2014

Doctors and nurses issue new guidance on making decisions about attempting cardiopulmonary resuscitation (CPR).

The British Medical Association (BMA), the Resuscitation Council (UK) and the Royal College of Nursing (RCN) are issuing new guidance today [1]regarding decisions about whether or not to attempt CPR on a person when their heart stops or they stop breathing.

Health professionals are aware that decisions about CPR can be very distressing for patients and people emotionally close to them, and decisions need to be handled carefully and sensitively.The revised edition of ‘Decisions relating to cardiopulmonary resuscitation’ 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.

A clear plan should be made to explain and/or discuss the decision with the person and/or their representatives at the earliest practicable opportunity.

Leaving people in the default position of receiving CPR should their heart or breathing stop, regardless of their views and wishes, denies them of the opportunity to refuse treatment that for many may not offer overall benefit and that many may not want.

The importance of involving people (or their representatives if they are unable to make decisions for themselves) in the decision-making process.

This often involves a person making a shared decision with their healthcare professionals, but where CPR has no realistic chance of success it may involve informing people of the decision and explaining the basis for it.

That when CPR has no realistic chance of success it is important to make decisions that are in the best interest of the patient, and not to delay a decision because a person is not well enough to have it explained to them or because their family or other representatives are not available.

The importance of careful documentation and effective communication of decisions about CPR.

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.”

Dr David Pitcher, Chairman of the Resuscitation Council (UK), said:

“When someone suffers sudden cardiac arrest, an immediate CPR attempt by members of the public and then by health professionals can be life-saving, and we encourage people to do everything they can to help in that situation.

“In contrast, trying to restart the heart of someone who is known to be dying from an advanced and irreversible condition provides no benefit and can do harm. Given the choice, many people do not want CPR in that situation, but it may be attempted if there is no discussion about it and no decision made.

“Deciding whether or not to attempt CPR can be really difficult for patients and for health professionals, but health professionals have a duty to make carefully considered decisions and to help their patients to make choices about their treatment. This guidance is to support all health professionals in fulfilling that duty, and should underpin the policies of all organisations that provide health care.”

Dr Peter Carter, Chief Executive & General Secretary of the RCN, said:

“Situations that involve attempts to resuscitate patients are among the most difficult for all concerned. What the new edition of the guidance makes clear is that with good, sensitive communication from staff, individuals can plan, make their wishes known, and understand the consequences of decisions around resuscitation attempts.

“Patients and their families benefit from the reassurance that the staff treating them, have access to the best guidance, based on years of experience and the strongest evidence. In working together to produce and improve this guidance, doctors and nurses are helping ensure that these difficult situations are managed in a way which does not add to the distress and confusion of patients or their loved ones.”

Note to editors

The British Medical Association (BMA) is the voice of doctors and medical students in the UK. It is an apolitical professional association and independent trade union, representing doctors and medical students from all branches of medicine across the UK and supporting them to deliver the highest standards of care.

The Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.

The Resuscitation Council (UK) exists to promote high-quality, scientific, resuscitation guidelines that are applicable to everybody, and to contribute to saving life through education, training, research and collaboration.

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