What is cardiopulmonary resuscitation (CPR)?

Cardiopulmonary resuscitation (CPR) is a way to try to restart your heart and breathing if they suddenly stop. Some people recover after CPR but it is not always successful.

Your healthcare team may talk to you about CPR and discuss how likely it is to work in your situation. Your team will consider your wishes about whether or not CPR should be given. However, a senior doctor will make the final decision based on the benefits and risks of CPR for you.

If you are in hospital, any decision about CPR will be written in your medical notes. If you go home, your community healthcare team should be told about the CPR decision. Your decision will be reviewed at times, and any changes written in your medical notes.

If you have not made a decision about CPR and your heart or breathing stop, your healthcare team will make the best decision they can, based on your medical situation at the time.

Your decision about CPR will not affect any other care or treatment you receive.

What is cardiopulmonary resuscitation (CPR)?

Cardiopulmonary resuscitation (CPR) is a way of trying to restart a person’s heart and breathing if they have stopped suddenly.

When the heart stops beating suddenly, this is known as a cardiac arrest. If the breathing stops, this is called a respiratory arrest. Usually, both happen at the same time. This is known as a cardiopulmonary arrest. If someone having a cardiopulmonary arrest does not have their heart and breathing restarted quickly, they will die.

A person’s heart or breathing can stop for different reasons. For example, a heart attack can cause the heart to stop.

CPR involves different treatments to help restart a person’s heart or breathing. The first treatment usually involves repeatedly pressing down on the person’s chest to help the heart pump blood around the body. This is called a chest compression. CPR may also include blowing air into the person’s mouth to push oxygen into their lungs. Unfortunately, these procedures can also cause injury, especially to someone who is frail or very ill. This can include broken ribs.

If CPR is given at home or in a public place, this may be the only treatment until an ambulance arrives.

If CPR is given in hospital, the doctors or nurses will also use other treatments. They may give drugs and use specialist equipment to give oxygen. They will use a machine called a defibrillator to monitor any heartbeat. They can also use the defibrillator to give shocks to start the heart again.

Some public places, such as airports or shopping centres, may have a portable defibrillator. This can be used to try to restart the heart. No specialised training is needed to use this.

A cardiopulmonary arrest is an emergency medical situation and can be frightening. It can be distressing to see someone being given CPR, especially if it is a loved one. The healthcare team involved will give support and information to any family or friends when they can. Close family and friends may be asked to leave the area while CPR is given. But some people choose to stay with their loved one.

How successful is CPR?

Only a small number of people will recover after having CPR. Some people will recover but will be left with serious long-term health problems. For others, CPR restarts the heart and breathing but the person is too unwell to recover. They may need ongoing medical support, such as a breathing machine (artificial ventilator) in an intensive care unit. They may continue to live for hours, days or sometimes weeks, but cannot survive without this support.

For many people, CPR does not restart the heart or breathing. Sadly, they die despite the treatment.

Whether CPR works can depend on:

  • the age and general health of the person
  • any other health problems
  • the reason the heart and breathing stopped
  • how quickly the heart and breathing can be restarted.

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.

There are many types of cancer and cancer treatment. Some people will have treatment that aims to cure the cancer. Others may have cancer that cannot be cured. Sometimes treatment itself may cause problems with the heart or breathing.

If a cancer is very advanced, the heart and breathing may gradually slow down and stop. This is part of the natural process of dying. In this situation, giving CPR is very unlikely to restart the heart. CPR may make the dying process longer and more distressing. It may also be more distressing for family and carers.

Talking about CPR

Your doctor or nurse may talk to you about CPR. They will discuss:

  • what is involved
  • the possible risks and benefits
  • whether CPR might work in your situation.

If CPR is unlikely to be successful, they will explain why this is.

They may discuss with you what the best treatment is likely to be if your heart or breathing stops. This can be difficult and upsetting to talk about. But it is important that you are included in the decision about whether or not CPR should be given.

If your doctor or nurse has not discussed CPR but you want to, you can speak to them about it. You may also want to talk things over with other people such as your partner, family, or religious adviser.

Making decisions about CPR

Your healthcare team should involve you as much as possible when making a decision about CPR. You may need time to think carefully about your situation. Think about what would be best for you if your heart and breathing stopped. Your team will consider your wishes about CPR. However, the final decision will be made by a senior doctor. They will think about the benefits and risks of CPR for you.

They will tell other members of the team that you have discussed CPR and what decision has been made. This information is confidential. It will only be shared with the team caring for you.

If you have told your healthcare team that you do not want CPR, they will accept your decision.

You may decide that you want CPR even if your healthcare team tells you it is unlikely to work. If you do not agree with your team’s advice, you can ask for a second medical opinion from another senior doctor. It is important to be aware that another doctor may have the same opinion as your healthcare team.

Sometimes, the healthcare team may decide that the person is not able to make the decision about CPR themselves. For example, this may happen if someone has a serious mental health illness, or is confused or disorientated.

Some people do not want to make their own decision about CPR. You do not have to talk about CPR with anyone or decide about CPR if you would prefer not to. Instead, you can let your healthcare team decide for you.

Recording the decision

The decision about CPR will be written clearly in your medical and nursing notes. If the decision has been made not to give CPR, this is written as a 'do not attempt resuscitation' (DNAR) order, or as a 'not for resuscitation' (NFCPR). The doctor usually also writes a date to review the decision in the medical notes. This means that the decision will be discussed again to check it is still correct and up-to-date. For people with advanced cancer, the doctor may write that the decision is indefinite.

If you are in hospital, the decision will be written in your medical and nursing notes. But they will not be in any notes stored beside your bed. If you leave the hospital ward, for example for an x-ray, your medical notes usually go with you. Many hospitals use stickers on the outside of medical notes to show that CPR should not be given. This helps any person looking after you find this information quickly. Your team will also aim to communicate clearly with staff in other departments. Anyone involved in your hospital care should know about a CPR decision.

If you go home from hospital, the community healthcare team looking after you should also be told about a CPR decision. This includes:

  • your GP
  • your local out-of-hours service
  • the ambulance service.

It may also include:

  • the community palliative care team
  • the district nurses
  • any carers.

Sometimes the DNAR decision will be written on a form that you can take home with you. If you are being cared for at home, check if the community healthcare team will accept the form. You will need to keep it in a safe place at home.

GPs or community palliative care teams will usually discuss CPR with the people they are looking after. But if they have not and you want to discuss it, ask to talk to them.

If no decision has been made

If your heart or breathing stops, your healthcare team will make the best decision they can at the time if:

  • you have not already made a decision
  • it is not clear what the decision is.

They will decide whether to give CPR based on your medical situation. If your heart or breathing stops at home and an ambulance is called, the paramedics will always give CPR. This is unless there is a clearly written DNAR or NFCPR order.

What if I am unable to make a decision about CPR?

In some situations, you may not be able to make a decision about CPR. For example, this might be if you are unconscious or too drowsy from medication.

If this happens, your healthcare team will make any final decision about CPR. They 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 discuss your care with certain people, they will respect this. They will not discuss 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 discuss any decision about CPR with your attorney. However, 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. However, your next of kin or relatives should still be asked for advice about the decision.

Recording your decision about CPR in advance

An Advance Decision to Refuse Treatment (ADRT) is a written statement of your wishes to refuse a particular treatment in a specific situation. It is called an Advance Directive (AD) in Scotland. It is a way of making sure that 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 discuss it with a healthcare professional. This may be your GP, or a doctor or nurse specialist 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.

If you decide that you do not want to be given CPR, you can record this in your written statement. A copy can then go into your medical notes for your healthcare team.

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 that you get.

Each time you are admitted to hospital, a doctor will check the CPR decision and discuss it with you. 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 there is a change following your discussion, your doctor will record it in your medical notes. Remember to tell your family or carer about any changes to avoid confusion.

If you would like to know more about CPR, you might find it helpful to look at the website TalkCPR.

Back to Coping with advanced cancer

Decisions about treatment

You may have lots of questions about your treatment options. You can talk to your doctors and nurses about these.

Who can help?

You can get care and support at home, in a hospital or in a hospice. This depends on your needs and preferences.

Making CPR decisions

You may be asked to make a decision with your family and healthcare team about whether you want cardiopulmonary resuscitation (CPR) to be attempted.