CPR (Cardiopulmonary Resuscitation) and DNACPR (Do Not Attempt Cardiopulmonary Resuscitation)
This page offers some general information about:
- What CPR is
- What CPR can and can’t do
- Why it is important to talk about CPR and DNACPR
- What a DNACPR is
Further down the page, you will find our Patient Leaflet ‘Information for patients and their carers to help with decisions about CPR (Cardiopulmonary Resuscitation)’. This is available in written, easy read, video, and sign language formats and goes into more detail about DNACPR. There is also an FAQ (Frequently Asked Questions) and links to other helpful resources.
Your healthcare team is always willing to talk about CPR and DNACPR with you. Please don’t hesitate to ask them.
Understanding and talking about CPR and DNACPR is not easy and can be upsetting. We suggest you take your time over the content of this page. You might want to read a bit, have a break and return to it another time.
What is CPR?
CPR is an emergency procedure that tries to restart someone’s heart after it stops beating. Hearts stop beating for many different reasons. This is why CPR helps some people but not others. CPR does not treat the problem that caused the heart to stop, but sometimes it can restart the heart and breathing so that other treatment can be given.
What is DNACPR?
Do not attempt cardiopulmonary resuscitation (DNACPR) is an advanced decision not to attempt CPR when a named patient’s heart stops beating. This decision is based on the illnesses or injuries the patient has and treatments that have already been given.
When is CPR likely to restart someone’s heart?
CPR is more likely to restart a heart in a ‘heart stops first’ situation – a cardiac arrest. This emergency happens when an acute medical condition or serious injury causes someone’s heart to stop suddenly. It is likely that the other organs of the person’s body were working well or reasonably well when their heart stopped.
CPR is a lot for someone to go through. Sadly, CPR can damage people and it is not always successful. In some heart stops first situations people recover and return to good health. They respond well to other treatments.
When is CPR not likely to restart someone’s heart?
CPR is very unlikely to restart a heart in a ‘heart stops last’ situation. The heart stops last at the end of illnesses, conditions and major injuries that can no longer be managed or reversed by any form of treatment.
When this happens, the human body becomes weaker. Sadly, the person becomes sick enough to die. When dying itself begins, a person’s body starts to close down. Over time they become more sleepy and then unconscious. Eventually, their breathing stops, their heart stops and death occurs. This is natural or ordinary dying, the close of life that comes to us all.
Dying is an important time. A time for being comfortable, cared for and with those we love around us.
Sometimes people die after a short serious illness or major injury. Often dying is the conclusion of illnesses or conditions we have lived with for many months or even years.
Why is it important to talk about CPR and DNACPR?
A healthcare team always tries to listen to a patient’s views and wishes and involve them in making a plan of care. It is good to do this when a patient is well enough to join in. If a patient finds it difficult to share their views, the team will have a discussion with their loved ones or legal proxy. A plan of care could include medicines, therapies and other types of care as well as CPR or not attempting CPR (DNACPR).
Discussions about CPR and DNACPR happen when it is thought that doing CPR would not be in a patient’s best interests. This means that the team does not think CPR will restart the patient’s heart when it stops at some point in the future.
Sometimes conversations like these can make us think about our future or the future of our loved ones. While this can make us feel sad, knowing that a plan has been made can help to ease our worries.
What does ‘having a DNACPR’ mean?
If CPR is either not wanted by a patient or not considered to be in a patient’s best interests, a Do Not Attempt CPR form is completed. An experienced member of the patient’s healthcare team fills in and signs a DNACPR form. This is overseen by a senior clinician.
The patient is now said to ‘have a DNACPR’. This protects a patient who does not want or would not benefit from CPR from suffering and harm. The patient continues to have all other treatment and care. When a patient with a DNACPR leaves the hospital, they take their DNACPR form with them. This is so that they can show it to others who care for them. Ambulance crews and community and hospital healthcare teams would want to see it Some people have a DNACPR in place for only a short time, others have one for many years.
For more information, please see our Patient Information leaflet, FAQ and Extra Information.
Patient Information Leaflet
‘Information for Patients and their Carers to help with Decisions about CPR (Cardiopulmonary Resuscitation)’
- NUH Patient Information Leaflet to help with decisions about CPR and DNACPR https://www.nuh.nhs.uk/download.cfm?doc=docm93jijm4n5255
- A video of one of our consultants reading the Patient Leaflet plus a few extra comments
- A video of our Patient Leaflet in sign language
- An Easy Read version of our Patient Leaflet (coming soon)
Frequently Asked Questions
We hope you have found the webpage and Patient Information leaflet helpful. Here we try to offer answers to other questions that we are sometimes asked about DNACPR:
Does a DNACPR decision affect my other care and treatment?
A DNACPR decision is about not doing CPR only. It does not affect other treatments. Medicines, surgery and therapies continue or can be added if needed. Some people who have a DNACPR develop new illnesses or have accidents. They receive appropriate treatment for these.
Can a DNACPR be made without my knowledge?
Healthcare teams assess all patients to see whether they have the mental capacity to take part in and understand a conversation about CPR and DNACPR. If a patient lacks this capacity, the healthcare team will try to discuss it with either the patient’s family member or legal proxy.
If a patient is able to understand a DNACPR decision, the team will discuss with them the decision.
If they talk to me about DNACPR does it mean I’m dying?
If this is worrying you, we encourage you or those closest to you to talk to your healthcare team. They will be able to answer this question more fully for you.
Many people we talk to about CPR and DNACPR are not dying. Some people have a DNACPR form in place for many years, others for only a short time. Talking about CPR and DNACPR is about making a plan for what will and won’t be done in future when the heart stops beating. CPR can’t reverse the natural, ordinary dying that comes to us all.
Having a DNACPR helps to ensure that we receive the most appropriate care when and as our lives end.
Do I or a family member have to sign anything?
Only an experienced member of a healthcare team can fill in and sign a DNACPR form. This is overseen by a senior clinician. There is nothing for the patient, their family or legal proxy to sign.
Is having CPR like it’s shown on TV?
Sadly not. It would be far too distressing to show CPR as it really is. CPR is tough, and the patient is very unwell.
Are DNACPRs made for groups of people?
No. This is illegal. A decision not to attempt CPR is made about an individual named patient only. It considers their medical conditions and the effect CPR would have on them. Every person matters and is unique.
Can my family object to or change a DNACPR decision?
DNACPR is a medical decision made in the best interests of a patient. Only the healthcare team can make and amend a DNACPR decision.
The healthcare team is available to discuss any concerns the people closest to the patient might have about a DNACPR decision.
The legal proxy of a patient with a Lasting Power of Attorney Health and Welfare can share the patient’s views about CPR with the healthcare team. This information may support the decision the team makes about CPR and the patient.
Click this link for more information about Lasting Power of Attorney https://www.gov.uk/power-of-attorney
As a family member, do I have a right to know about DNACPR decisions?
If your relative has capacity and does not want you to know about their medical or care decisions, you are not entitled to be given this information.
We encourage patients to tell those close to them about a DNACPR decision so that their wishes are known.
Can DNACPR decisions be reviewed?
It is recommended that DNACPR decisions are reviewed. This can be when a patient moves from one care setting to another or something about their health changes. A DNACPR can be updated or cancelled.
What’s the difference between a DNACPR and an Advance Decision to Refuse Treatment (ADRT)?
A DNACPR is an advanced decision not to attempt CPR. It is not about other treatments or care. A DNACPR is not legally binding but will respected by all healthcare teams.
An ADRT is defined by the Mental Capacity Act 2005 as a legally binding document. These documents are created by and for a person who has capacity to make decisions about the treatments or procedures they would not wish to receive, and the circumstances in which those decisions would apply. An ADRT is legally binding.
Click this link for more information about ADRT https://www.nhs.uk/conditions/end-of-life-care/advance-decision-to-refuse-treatment/
What’s the difference between a DNACPR and a ReSPECT form?
A DNACPR is an advanced decision not to attempt CPR. It is not about other treatments or care.
A ReSPECT form records a patient’s wishes about a range of care and treatments. It includes information about attempting or not attempting CPR. ‘ReSPECT’ stands for Recommended Summary Plan for Emergency Care and Treatment.
Click this link for more information about ReSPECT https://www.resus.org.uk/respect
Who else can I talk to?
- Any member of your healthcare team including your GP
- Those closest to you
- A chaplain from our multifaith Department of Spiritual and Pastoral Care
- Your own spiritual adviser
- Patient support organisations such as Age UK, Macmillan Cancer Support and other condition specific charities
- Dying Matters - let’s talk about it www.dyingmatters.org/
- Independent advocacy services. An advocacy service can help you express your views or make your own decisions, or can speak on your behalf.
Useful websites for further information:
Talk CPR- Doctors Speak about Sharing and Involving and challenges in our approach to DNACPR
If you are unable to watch the video above, then please click on the link below to access the YouTube link directly:
- Guidance from the British Medical Association (BMA), the Resuscitation Council (UK), and the Royal College of Nursing (RCN) can be found at: www.resus.org.uk/dnacpr/decisions-relating-to-cpr/
- Advance Decision to Refuse Treatment: https://www.nhs.uk/conditions/end-of-life-care/advance-decision-to-refuse-treatment/
- NUH DNACPR patient leaflet: https://www.nuh.nhs.uk/download.cfm?doc=docm93jijm4n5255.pdf&ver=10849
- Lasting Power of Attorney - Health and Welfare: www.gov.uk/government/organisations/office-of-the-public-guardian
- If you need the help of an interpreter or translator, see https://www.nuh.nhs.uk/download.cfm?ver=19487
- Dying isn’t as bad as you think – a BBC video with palliative care consultant Dr Kathryn Mannix https://youtu.be/CruBRZh8quc