What is CPR?
CPR is a treatment that is used to try to restart someone’s heart and
breathing when one or both of these has stopped. When the heart
stops this is called a cardiac arrest and when the breathing stops
it is a respiratory arrest. If one stops, the other usually stops soon
afterwards (cardiorespiratory arrest).
CPR includes:
• repeatedly pushing down very vigorously on the centre of the chest;
• blowing air or oxygen into the lungs, using either a mask over the nose and mouth or a tube inserted into the throat or windpipe; and often
• using electric shocks to try to restart normal heartbeats.
What is the chance of CPR restarting my heart and breathing?
There is no simple answer to this, because everybody is different.
The chance of CPR restarting your heart and breathing will depend
on:
• why your heart and breathing has stopped;
• any illnesses or medical problems you have (or have had in the past);
• the overall condition of your health.
Many attempts at CPR do not restart the person’s heart and
breathing despite the best efforts of everyone involved. For example,
when CPR is attempted in hospital, on average about 2 out of 10
patients survive to leave hospital. In places other than a hospital, the
chances of survival are usually even lower.
For some people the chance of survival will be much better than this
and for others there will be no chance of benefit from CPR.
If you want more information, your healthcare team can usually
explain more clearly what the likelihood of CPR working for you
would be if your heart or breathing were to stop.
Is CPR tried on everybody whose heart and breathing stop?
No. It’s important that CPR is not tried on everybody whose heart
and breathing stop. For example, when someone is coming to the
end of their life as a result of an advanced, irreversible illness, and
the heart and breathing stop as part of the natural process of dying,
CPR will not prevent their death.
If CPR does restart the heart and breathing in these circumstances
it can leave a dying person with more distress or worse health in
the last hours or days of their life. For others, receiving CPR would
deprive them of dignity during the very last moments of their life. For
these reasons many people choose not to receive CPR when they
know that they are coming close to the end of their life.
Such a decision not to attempt CPR is often called a ‘Do Not Attempt
CPR’ or ‘DNACPR’ decision. Nowadays, if possible, many healthcare
teams will try to discuss with individual people their wishes about
CPR and to record when CPR would still be wanted, as well as when
it isn’t wanted or wouldn’t work.
Do people make a full recovery after CPR?
Although many people do make a full recovery, some recover but
still have poor health, and some people will be left in worse health
after resuscitation from cardiorespiratory arrest. The likelihood of full
recovery depends largely on:
• why the heart and breathing has stopped;
• the overall condition of a person’s health;
• how quickly CPR is started.
Although whether to give CPR is a decision made by your medical
team based on its likelihood of success they will discuss the benefits
and burdens of CPR with you.
Those who are resuscitated by CPR are often still very unwell and
need more treatment, usually in an intensive care unit (ICU) or
sometimes a cardiac care unit. In some cases a person may be left
with permanent brain damage or in a coma.
CPR can cause unwanted effects such as bruising, broken ribs and
(infrequently) damage to internal organs such as the lungs or liver.
When there is a real chance that CPR could bring a person back
to a length and quality of life that they would want, the risk of these
unwanted effects is not usually enough for them to decide that they
don’t want CPR.
Will I be asked whether I want CPR?
This will depend on your circumstances:
• Usually, if your heart and breathing are unlikely to stop, health
professionals will not discuss CPR with you unless you ask
them to. Where no decision has been made in advance about
whether or not CPR should be performed, it will be assumed
that CPR should be attempted if cardiorespiratory arrest occurs
unexpectedly. If that may not be what you want, it is important
to discuss your wishes with your healthcare team.
• If there is a chance your heart and breathing will stop and that
CPR might be successful your views on CPR, your medical
condition and the likely outcome of attempting CPR are all very
important in deciding whether CPR is the right choice for you.
The health professionals looking after you will want to know
what you think and make a shared decision with you.
• If CPR will not prevent your death should your heart and
breathing stop, your healthcare team will make a decision not
to attempt CPR. They will explain to you the decision and the
reasons for it, unless they believe that telling you will cause you
physical or psychological harm.
If you wish, your family or close friends can be involved in these
discussions. If you disagree with a decision about CPR, you can
request a second opinion.
What will happen if no decision has been made?
In an emergency, when someone collapses and their heart and
breathing stop without warning, health professionals will try to restart
the heart and breathing if:
• there is a chance that CPR will work, and
• the person is not known to have decided against receiving CPR.
What if I don’t want to discuss CPR?
You don’t have to talk about CPR if you don’t want to, or you can ask
to delay the discussion until you are ready for it.
In these situations, the health professional in charge of your care will
have to make a decision in your best interests about what to do if
your heart or breathing stops, taking into account your general views
and wishes.
Does it matter how old I am or that I have a disability?
No. What is important is:
• your views and wishes;
• your state of health; and
• the likelihood of the healthcare team being able to achieve what you want.
What if I am unable to take part in a decision about CPR?
If you cannot take part in making a decision about CPR or about
other types of treatment, because you are too unwell to understand
information, to make a considered choice, or to communicate your
wishes, these decisions will be made for you.
In England and Wales:
• You can plan ahead for this situation by choosing somebody
who you want to be involved in future decisions if you are
unable to take part. You do this by arranging to give them a
“Lasting Power of Attorney” (LPA) for your health and welfare.
• The Court of Protection may also appoint a “Deputy” with
similar powers.
• If, like many people, you do not have a LPA or Deputy, the
health professional in charge of your care will make a decision
about what is best for you, taking into account your previously
expressed wishes. They will ask your family or close friends for
information about these. If you have no family or friends to ask,
an “Independent Mental Capacity Advocate” may be asked to
help.
More information on how healthcare decisions are made in England
and Wales, when people are unable to take part in decisions, can be
found under “Mental Capacity (What is the Mental Capacity Act)” at
www.nhs.uk
In Northern Ireland:
The health professional in charge of your care will make a decision
about what is best for you, taking into account your previously
expressed wishes. They will ask your family or close friends for
information about these.
In Scotland:
• You can plan ahead for this situation by choosing somebody
who you want to be involved in future decisions on your behalf
You do this by making them your “Welfare Attorney”.
• The Sheriff may also appoint a “Welfare Guardian” with similar powers.
• If you do not have a Welfare Attorney or Guardian, the health
professional in charge of your care will make a decision about
what will benefit you, taking into account your previously
expressed wishes. They will ask your family or close friends for
information about these.
More information on how healthcare decisions are made in Scotland,
when people are unable to take part in decisions, can be found
under “Adults with Incapacity (Adults with Incapacity Act)” at www.
mwcscot.org.uk/
Can my family decide for me?
If you are unable to take part in discussions around CPR, your family
or close friends may be able to on your behalf. It is therefore important
that you discuss your wishes with them. If there are people who you
do or do not want to be told about your condition or asked about your
care and treatment, you should let your healthcare team know.
I know that I don’t want anyone to try CPR on me. How can I make sure they don’t?
If you don’t want CPR, you can refuse it and if they know of this
refusal the healthcare team must follow your wishes. It is very
important to ensure that your wishes are recorded clearly and
that you make them known to your family or other carers and to
your healthcare team. Healthcare professionals called to you in an
emergency will need immediate access to any document recording
your wishes.
You can make an ‘Advance Statement’ of Preference to put in
writing your wishes about any type of care or treatment that you
would or wouldn’t want to be considered for if you are not able to
decide for yourself at the time. Although not legally binding, this can
be important to guide health professionals who may not know you
well but are having to decide what treatment would be in your best
interests.
In England and Wales, you can also make an “Advance Decision to
Refuse Treatment” (ADRT). This must be signed by you and by an
independent witness and is legally binding. To refuse CPR it must
state that you refuse it even if your life is at risk.
If you have made an ADRT or any other type of Advance Statement
of Preference, you should make sure that your healthcare team
knows about it and puts a copy of it in your records. You should
also make sure that people close to you know about it and where
you keep it, so that they can find it easily in an emergency and
show health professionals what decisions or preferences you have
recorded.
If it is decided that CPR won’t be attempted, what then?
This is often called a “Do Not Attempt Cardiopulmonary
Resuscitation” or “DNACPR” decision. Together with the reasons for
the decision, it is usually recorded on a special form that makes it
easy for health professionals to recognise.
Increasingly, similar forms are used to record both a decision
whether or not CPR should be attempted, and decisions made in
advance about other types of care and treatment that a person may
or may not want to be considered for, especially as they approach
the end of their life. For example, these choices may include
decisions about wanting to have treatment at home and not be
admitted to hospital, or choices about wanting hospital treatment but
not wanting to be considered for admission to an intensive care unit.
Most decisions recorded on such forms will be reconsidered if your
condition changes or if you are transferred, for example from hospital
to home, to a nursing home or hospice, or from one hospital ward to
another. The form should travel with you, so that it is always readily
available to guide any health professional if your condition worsens.
What about other treatment?
A DNACPR decision is about CPR only and you will receive all the
other treatment that you need. If you have recorded a refusal of other
treatments that will also be used to guide decisions about your care
if your health deteriorates and you are unable to make clear choices
at the time.
If it has not been suggested already, you may want to discuss with
your healthcare team and plan with them what other types of care
and treatment you would or would not want to be considered for if
your health deteriorates.
What if I want CPR to be attempted, but the healthcare professional in charge of my care
says it won’t work?
When a decision is made that CPR will not work because a person
is dying from an advanced and irreversible condition it will usually
have been discussed and agreed among several members of the
healthcare team. If you are not willing to accept the explanation and
advice that they have given you, they will arrange a second opinion
for you if you would like one.
It is important to remember that you are not entitled to demand
treatment that is not being recommended or offered. However, health
professionals will not refuse your wish for CPR if there is any real
possibility of it working successfully.
If CPR might restart your heart and breathing, but is likely to leave
you in very poor health, your opinion about whether these chances
are worth taking is very important.
The healthcare team should listen to your opinions and anyone close
to you that you want to be involved in the discussion. In most cases,
health professionals and their patients agree about treatment where
there has been good communication.
What if I change my mind or my situation changes?
Your healthcare team will keep the decision about CPR under
review, in particular if your condition changes, if you move to a
different care setting or go home, or if you want to change your mind.
Can I see what’s written about me?
Yes. You can see what’s written about you.
You can ask the healthcare team to show you your records and,
if there is anything in them that you do not understand, they will
explain it to you.
Who else can I talk to about this?
In addition to the healthcare team looking after you, there are other
people you may want to talk to about CPR, for example:
• patient support groups
• spiritual advisers
• independent advocacy services
Use this space to write down any questions that you may want to discuss with anyone,
including your healthcare team.
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Author End of Life Team
Approved by End of Life Meeting
Date of Publication 19/02/2024
Reference No PL/1081 (v3)
Review Date 01/02/2027
