Do Not Attempt Resuscitation!

Some people are asked about resuscitation as part of their care package. It can seem a very scary thing to be discussing, and a lot of patients, friends and relatives possibly do not understand what it really means.

Do not attempt resuscitation (DNAR) decisions refer only to cardiac and pulmonary resuscitation (CPR). That means a failure of the heart to beat or lungs to breathe. It does not refer to any other investigation or treatment that some-one may need after they have made a DNAR decision.

CPR is very invasive. It has significant adverse effects including fractured ribs, fractured breast bone, tearing of the liver or spleen, prolonged Intensive Care Unit (ICU) treatment and possibly artificial ventilation (where a machine takes over breathing for you). Following resuscitation, the person may be left with significant brain damage and disability – particularly if there is some time delay before CPR commences. CPR can be very traumatic, so that death occurs in a manner that neither the person nor the people close to that person would have wished.

Survival rate after attempted CPR is better in hospital, but at the very best only 15-20%. In the community the very best is 5-10%. Success depends on many factors including:

• What caused the arrest?
• How soon did CPR commence?
• Who is available to deliver it?

Successful CPR is usually followed by a period of observation and treatment in ICU, Coronary Care Unit (CCU) or both and there may be a need for extensive therapy following on.

Thankfully for most people the likelihood of an arrest is small. However for some people, there is an identifiable risk, either because of an incurable condition such as terminal cancer, or a recent heart attack or stroke, or an acute problem such as severe infection. It is best to try and decide in advance what each individual would like to happen, rather than making a snap decision in a crisis.

No-one assumes that the same decision would apply to everyone in the same clinical situation. Everyone has different ideas on what they would wish for themselves. The decision should be an objective view of what would be in that person’s best interest taking into account all the medical and other factors and most importantly, that person’s own views.

When someone is in the final stage of an incurable illness, CPR is very unlikely to be successful and if it is, it is more likely to prolong or increase suffering and subject that person to a traumatic and undignified death,

People can decide before they are ill what they would like to do for the best in particular circumstances. It is called an Advance Decision or Living Will. You put into writing what your wishes are. You can leave a copy with your doctor, but it is more important that you tell your close friends and relatives as your GP may not know of an emergency admission and so be unable to pass on the vital information. Always advise any doctor treating you of your wishes in your Living Will.

Once a decision is made, it is not irrevocable. People are allowed to change their minds as situations and feelings can vary.

Most importantly, DNAR applies only to CPR. Any other investigations, treatment or care will continue as if a DNAR had not been implemented.

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