Emergency care and resuscitation plans

Abstract

When a person's heart or breathing stops and the cause is reversible, immediate cardiopulmonary resuscitation (CPR) offers a chance of life.However, when a person is dying-for example, from organ failure, frailty, or advanced cancer-and his or her heart stops as a final part of a dying process, CPR will not prevent death and may do harm."Do not attempt CPR" (DNACPR) decisions were first documented in the 1970s, to try to protect people from receiving CPR that they did not want, that would not work, or would not give them overall benefit.This approach of making CPR decisions separately from decisions about other treatments has been challenging for clinicians and patients and has caused problems.[1][2][3][4] Despite national guidance in the UK (see "Further educational resources" box), misunderstandings, poor communication, and inconsistent DNACPR documentation persist.4 Exploring and achieving a shared understanding among patient, family, and healthcare team of realistic and individualised care preferences may sometimes be done badly or not even attempted.Here we draw on evidence (box 1), collated for a broader project, to outline how clinicians might plan with their patients.We offer suggestions on how clinicians and their patients might better think ahead, consider, discuss and record patient-centred recommendations, not only about CPR but also other elements of emergency care and treatment.In a linked article Fritz et al explain why a change in practice and culture, timing and context of these conversations is needed.