Cardiopulmonary resuscitation (CPR)
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What is cardiopulmonary resuscitation (CPR)?
Cardiopulmonary resuscitation is a way of trying to restart a person’s heart and breathing if they have stopped suddenly. It is more commonly called CPR.
It is not common for the heart or breathing to stop suddenly, but it is something that your doctor or nurse may talk to you about.
CPR can work well in some situations but not in others. Discussing and recording a decision about CPR means this treatment is more likely to be given only when it is useful. It means it is less likely to be given to someone who:
- does not want to be resuscitated
- is too ill or frail to benefit from CPR.
This is why you may be asked about CPR, particularly when in hospital.
CPR usually involves:
- repeatedly pressing down on the chest, to help the heart pump blood around the body
- blowing air into the mouth to push oxygen into the lungs.
It may also involve using drugs or medical equipment to restart the heart or give oxygen.
How successful is CPR?
Whether CPR works can depend on:
- the age and general health of the person
- any health problems they have
- the reason the heart and breathing stopped
- how quickly the heart and breathing can be restarted.
A small number of people will recover after having CPR. Unfortunately, for many people, CPR does not restart the heart or breathing.
For people affected by cancer, the success of CPR may also depend on:
- the type and stage of the cancer
- any cancer treatment they are having.
CPR is not suitable for someone who has very advanced cancer and is in their final days of life. In this situation, it is natural that the heart and breathing gradually slow down and stop as the person dies. Giving CPR is very unlikely to restart the heart.
CPR can also cause injury, such as broken ribs, especially to someone who is frail or very ill. It may make the normal dying process longer and more distressing. It may also be more upsetting for loved ones.
Talking about CPR
The medical team makes the decision whether or not to give CPR. But they need to involve you in the discussion.
This may be something you have already thought about. If you have already decided that you do not wish to be resuscitated, it is important that the decision is written down (see below).
If you have not thought about CPR, your doctor or nurse may talk to you about this decision. They may give you information about what the best treatment is likely to be if your heart and breathing stops. They may ask what care and treatment you would prefer to be given in an emergency.
This can be hard and upsetting to talk about. But it helps your healthcare team understand what is important to you. In an emergency, you may not be able to explain what you want. Your team may have to make decisions about your care quickly. If they already know what is important to you, this can help them make the best decisions for you.
If your doctor or nurse has not talked to you about CPR, you can speak to them about it. You may also want to talk about it with someone else. This could be a partner, family member, close friend or religious adviser.
Making decisions about CPR
If your heart or breathing stops, your healthcare team will always make the best decision they can at the time about whether to use CPR. If they know you have a written decision about CPR, they will use this to guide them.
If your heart or breathing stops at home and an ambulance is called, the ambulance team will always give CPR unless they know there is a clearly written decision.
DNA CPR decisions
DNA CPR stands for ‘Do not attempt CPR’. It is also sometimes called NF CPR (‘Not for CPR’) or DNAR (‘Do not attempt resuscitation’).
A DNA CPR is a written decision not to give CPR if your heart or breathing stops. The decision is made and recorded by a senior member of your healthcare team, such as your GP, cancer doctor or specialist nurse.
If they think CPR could be successful, they may ask what you would prefer. For example, this could be if you have cancer that cannot be cured, but you are expected to live with it for a long time. In this situation, you may want to know how successful CPR might be. Your team will make sure you have all the information you need to help you think about this.
They may feel that CPR will not be successful. If you do not agree, you can ask another senior health professional for a second opinion. It is important to be aware that they may have the same opinion.
Your healthcare team will consider your wishes about CPR. However, you cannot insist that they give you CPR if they do not think it will work. Your healthcare team will use their clinical knowledge to decide whether to give CPR. The final decision will be made by a senior doctor. They will consider the benefits and risks of CPR for you. Your doctor should also involve your next of kin or family, unless you have specifically asked them not to.
You may not want to be involved in making decisions about CPR. You do not have to talk about it or make a decision if you would prefer not to. Your healthcare team will ask you how much information you want. Together, you can make the decision that is right for you.
Recording a decision
There are different ways of recording a CPR decision in writing:
- A ‘Do not attempt CPR’ (DNA CPR) decision is made and written by a senior member of your healthcare team.
- An Advance Decision or Directive records your own decision to refuse CPR.
- A ReSPECT form is made with you by your healthcare team. It records your preferences.
Many healthcare teams use a standard form to record DNA CPR decisions. Or the decision may be written clearly in your patient record if you are in hospital. Sometimes this includes a date to review the decision. This means the healthcare team will discuss the decision again, to check it is still correct and up to date. For people with advanced cancer, the review date may be written as indefinite. This means it is unlikely to change or be reviewed.
DNA CPR information is confidential. It will only be shared with the team caring for you. This can include community teams if you are at home.
Advance Decisions or Directives
If you have decided you do not want CPR if your heart or breathing stops, you can record this using:
- an Advance Decision to Refuse Treatment (ADRT) in England and Wales and in Northern Ireland
- an Advance Directive (AD) in Scotland.
This is a written statement of your wishes to refuse a particular treatment in a specific situation. It is a way of making sure everyone knows in advance if there is a treatment you do not want to have.
Before making an ADRT or AD, it is important to talk about it with a health professional. This may be your GP, or a doctor or specialist nurse looking after you at the hospital. They can tell you what might happen if you stop a particular treatment or decide not to have it. They will also make sure your written statement meets legal requirements.
A copy can then go into your patient record for your healthcare team.
ReSPECT
ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. This system is used in many but not all areas of the UK. Your healthcare team will explain if they use it.
The plan includes information about you and your health. It explains:
- what is important to you
- your preferences for care in an emergency.
It also explains what your healthcare team think is best for you. This includes whether or not CPR should be given if your heart and breathing stop.
The plan is made with you by your healthcare team. The information is stored in your patient record. It is also usually written on a standard form that stays with you. If you go into hospital, take the form with you. If you are at home, keep it somewhere safe.
Sharing CPR decisions
If you have a written decision not to have CPR, make sure any health professional caring for you knows. This means they will be aware of the decision in an emergency.
If you have an Advance Decision to Refuse Treatment (England and Wales and Northern Ireland) or an Advance Directive (Scotland):
- tell your GP
- tell other health professionals involved in your care, such as your cancer doctor or specialist nurse.
You may also want to keep a copy at home or give a copy to family or friends who support you.
A DNA CPR decision and ReSPECT plan are often recorded using a standard form and also recorded in your patient records. Your healthcare team will share these with anyone involved in your care in hospital or at home. They should give you a copy to keep at home. You need to keep this safe and somewhere it can be found in an emergency.
What if I cannot tell my team what I think about CPR?
In some situations, you may not be able to talk to your healthcare team about CPR decisions. For example, this might be if you are unconscious or too drowsy from medication.
If this happens, your healthcare team will think about your medical situation carefully. They will also talk to people close to you, such as your next of kin or family. This is because these people may be able to suggest what decision you would make.
If you have asked your healthcare team not to talk about your care with certain people, they will respect this. They will not talk about the CPR decision with those people.
You may have arranged for someone to help make decisions for you if you are unable to.
- In England and Wales, this person is called a health and welfare attorney. They must be named in a legal document called a lasting power of attorney (LPA).
- In Scotland, this person is called a welfare attorney. They must be named in a legal document called a power of attorney (PoA).
Your healthcare team must talk to your attorney about any decision about CPR. But if the healthcare team decides giving CPR will do you more harm than good, your attorney cannot demand treatment.
In Northern Ireland, attorneys do not make decisions about medical treatment. But your next of kin or family should still be asked for advice about the decision.
Will a decision about CPR affect the rest of my treatment or care?
A decision about CPR will not affect any other care or treatment you get.
Each time you are admitted to hospital, a doctor will check the CPR decision and talk to you about it. This is important, because your medical condition or decision may change.
You may change your mind and want to review your decision. You will need to talk to your healthcare team about this. If the decision changes after you talk about it, your doctor will record it in your medical notes. Remember to tell your family, next of kin or carer about any changes to avoid confusion.
Talk CPR has more information about CPR.
About our information
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References
Below is a sample of the sources used in our advanced cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
Health Improvement Scotland/ NHS Scotland. Scottish Palliative Care Guidelines. Available from www.palliativecareguidelines.scot.nhs.uk/ [accessed Nov 2021].
NICE. End of life care for adults: service delivery. NICE guideline NG142 [Internet]. 2019. Available from www.nice.org.uk/guidance/ng142 [accessed Nov 2021].
NICE. Improving supportive and palliative care for adults with cancer. Cancer service guideline CSG4 [Internet]. 2004. Available from www.nice.org.uk/guidance/csg4 [accessed Nov 2021].
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Viv Lucas, Consultant in Palliative Medicine.
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